Managed Healthcare Executive - January 2009 - (Page 25)

{ HEALTH MANAGEMENT } Dual eligibles best served with coordinated bene t design Flexibility needed in FFS and capitated environments in order to weave in care coordination, disease management BY SHELLY REESE 40% of all Medicaid spending and about 25% of Medicare spending, and account for roughly 10% of all health spending in the United States. On paper, dual eligibles have what George Mason University Professor Mark Meiners calls “the gold card” of coverage. They receive acute care coverage under Medicare, while Medicaid lls in the gaps and covers long-term care. But what’s on paper often bears little resemblance to reality. SEARCHING FOR SOLUTIONS Shelly Reese is a freelance writer based in Cincinnati. Experts generally agree that lack of coordination between the Medicare and Medicaid systems is a major stumbling block. Medicare and Medicaid often force dual eligibles to access services from different systems with di erent rules, case managers and telephone numbers, using di erent identi cation cards and procedures. That duplication not only drives cost, it impacts quality of care. But bridging the two systems presents an enormous challenge. As director of the Robert Wood Johnson Foundation’s AUGHT BETWEEN A ROCK AND A Medicare/Medicaid Integration Project, hard place. If the cliché wasn’t coined to George Mason University’s Meiners has describe the plight of individuals who are been studying the dual eligible population eligible for both Medicare and Medicaid, it should since 1995. He’s studied states with fully have been. While dual eligibles may be entitled to integrated models, partially integrated comprehensive bene ts, their care is rarely coordi- systems and managed fee-for-service nated, a fact that endangers their health and costs programs. taxpayers billions. “There are a lot of models out there, Nearly 8 million people are dual eligibles: elderly but after 13 years, I haven’t seen a lot of or disabled Medicare bene ciaries who also qualify progress on the issue,” he says. Meiners for Medicaid coverage because of their poverty. Car- believes that’s partly due to the fact that ing for these patients cost U.S. taxpayers an esti- useful strategies, such as care coordination mated $239 billion in 2008, according to a recent and disease management, can be di cult study by the Lewin Group. They represent about to weave into a FFS environment. Rolf Bruderer/Blend Images/Getty Images C JANUARY 2009 25

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - January 2009

Managed Healthcare Executive - January 2009 Contents Editorial Advisors For Your Benefit News Analysis Politics & Policy Letter of the Law Managed Care Outlook New Day 5 New Realities of Disease Management Pharmacy Best Practices Health Management Technology State Report: Hawaii MHE Resource Ad/Edit Index

Managed Healthcare Executive - January 2009

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