Articles Examine Data and Issues For Expanding Integrated Care Models For Dual-Eligible Beneficiaries

As state and federal policymakers move to develop and test integrated care models for people dually eligible for Medicare and Medicaid, two new Kaiser Family Foundation articles in the June 2012 issue of Health Affairs highlight the diverse needs and challenges facing these 9 million beneficiaries, describe their current care arrangements, and raise issues to consider for proposed reforms aimed at better coordinating their care and reducing health care spending.

The first highlights the diversity of the dual-eligible population, which includes low-income elderly beneficiaries and younger people with disabilities, those using long-term services and supports, and many others living with a wide range of health conditions and disabilities. The commentary suggests targeting care models and payment reforms to meet the needs of specific groups of beneficiaries, expanding programs slowly over time to allow managed-care plans to build their provider networks, and not counting cost savings before they materialize. Dx For A Careful Approach To Moving Dual-Eligible Beneficiaries Into Managed Care Plans is authored by the Foundation’s Tricia Neuman, Barbara Lyons, Jennifer Rentas and Diane Rowland.


The second examines data on current care arrangements for dual-eligible beneficiaries, assesses the extent to which dually eligible beneficiaries are enrolled in managed or coordinated Medicare or Medicaid plans, and examines companies’ experience in providing care for this population in Medicare or Medicaid managed care plans. The study finds that most dually eligible beneficiaries receive Medicare and Medicaid services through unmanaged, uncoordinated care arrangements. However, many managed care companies provide both Medicaid and Medicare benefits to this population in non-integrated ways. The study also found wide variation across states, and gaps in the data about dually eligible beneficiaries’ experiences with coordinated care plans. There is Little Experience and Limited Data to Support Policy Making on Integrated Care for Dual Eligibles is authored by Marsha Gold of Mathematica Policy Inc. and the Foundation’s Gretchen Jacobson and Rachel Garfield.


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