Dual-Eligibles – Containing Cost While Ensuring Protections

 

July was a busy month for policy developments concerning people who have both Medicare and Medicaid, also known as dual-eligibles. The U.S. Department of Health and Human Services on July 8, 2011 announced several initiatives aimed at improving the quality of care for the dual-eligible population. One initiative is a demonstration that would test new financing structures for coverage delivery through two different models. Under the first model, states would enter into three-way contracts with the Centers for Medicare & Medicaid Services (CMS) and a managed care plan that would be provided with a capitated payment to administer both Medicare and Medicaid. The second model allows states to share in savings achieved as a result of initiatives designed to improve quality and coordination of care for dual-eligibles while reducing costs to the Medicare and Medicaid programs. The other two initiatives announced last week include the establishment of a resource center for states, which will assist them in delivering better coordinated care to high-need, high-cost beneficiaries, and a program designed to help states reduce preventable hospitalizations for nursing home patients. The initiatives will be administered through various offices within CMS, including the CMS Innovation Center and MMCO.

A new paper released by the National Senior Citizens Law Center (NSCLC) illustrates the importance of including consumer protections in these models. The paper, titled “Ensuring Consumer Protection for Dual Eligibles in Integrated Models,” highlights the importance of ensuring that models are designed not solely to create savings, but primarily to improve care quality, coordination and experience for this population. Recommendations include preserving choice of coverage and providers, ensuring continued access to the most generous benefits from both Medicare and Medicaid, and providing extensive and proactive oversight of all integrated models. 

Read more about the new HHS dual-eligible initiatives.

Read NSCLC’s paper, “Ensuring Consumer Protection for Dual Eligibles in Integrated Models.”

-From “Ensuring Consumer Protections for the Dual-Eligible Population” , Medicare Watch, Medicare Rights Center, July 14, 2011.

 

 

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