Better Care for Dual Eligibles

April 04, 2012
9:37 am

When you examine the rising costs in our healthcare system, an important starting point is the care required by the so-called dual eligibles, those Americans who are eligible for both Medicare and Medicaid.  There are nearly 10 million individuals nationwide who fall into this category and they utilize a disproportionate share of healthcare services because of a high propensity for chronic disease and need for acute care.

Dual eligibles account for 27 percent of Medicare’s spending, although they represent only 16 percent of beneficiaries.  That gap is even wider in Medicaid.  According to a Wall Street Journal article last year, one reason costs are so high for this patient group is imperfect coordination between Medicare and Medicaid which is contributing to “hundreds of thousands of hospitalizations that could be avoided.”

A new report released this week shows that progress can be made in providing better, more cost-effective care to the dual eligible population.  Avalere Health, a highly-regarded research and analysis firm specializing in health policy, has studied an integrated care model developed by SCAN Health Plan, a health insurer serving 130,000 Medicare Advantage beneficiaries in California and Arizona.  (SCAN is also a member of the Healthcare Leadership Council.)

The Avalere study found that SCAN’s team-oriented case management approach for dual eligible patients, utilizing individually-tailored care plans, has resulted in hospital readmission rates that are 25 percent lower than traditional fee-for-service Medicare.  SCAN also outperformed conventional Medicare by 14 percent in prevention indicators, maintaining patient wellness and keeping them out of the hospital.

As Avalere senior vice president Bonnie Washington put it, “Better coordinated care for low-income elderly patients is a critical imperative for federal and state governments.  This study shows that well-developed care management models can result in measurable differences in quality, hospitalization and rehospitalization – and cost savings – for a vulnerable population in need of close care coordination.”

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