Moving Dual Eligibles to Managed Care Involves Careful Reform

Payment and provider reform is needed to cover the 9 million people who are eligible for both Medicare and Medicaid benefits, but policymakers need to take a careful approach when developing new payment and care models for dual eligibles, according to a Health Affairs report.

"The Affordable Care Act opens the door for new approaches for coordinating care for dual eligible beneficiaries who are among the sickest, frailest, poorest and most costly on Medicare," lead author of the report and Vice President of the Kaiser Family Foundation Patricia Neuman said in a statement. "Because these beneficiaries have complex but diverse needs, this effort will require highly targeted solutions, sound planning and careful oversight to truly realize improvements in care management and savings."

Ms. Neuman and the other authors discuss the complexity and heterogeneity of the dual-eligible population and encourage focusing on subgroups of dual-eligible beneficiaries rather than taking a sweeping approach to care reform for dual eligibles. The report also warns against moving too quickly to reform care for dual eligibles because of the time and resources needs to serve that patient population. Additionally, the report cautions against being overly optimistic about current savings assumptions that might not materialize.

As of May 2012, 26 states were exploring partnerships with the federal government to experiment with capitated payments and managed fee-for-service approaches to caring for patients who qualify for both Medicaid and Medicare.

The cost to care for a dual-eligible beneficiary is fives times that of an average Medicare beneficiary, according to the Kaiser Family Foundation.

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Less Than 1% of Dual Eligibles Considered "High-Cost" Beneficiaries

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