Washington, DC and Boston, MA—As states facing record budget deficits and the federal government look to enact quality and efficiency provisions in the Afforadable Care Act for the 8.8 million Americans enrolled in both Medicare and Medicaid—or “dual eligibles—governments need to take concrete steps to ensure better health outcomes for this population, according to a report released today by the Center for American Progress and Community Catalyst.
The report, “The Role for States in Improving Care for Dual Eligibles: Learning Lessons and Moving Forward,” outlines a series of principles states and the federal government should adopt prior to integrating care for dual eligibles. These include:
Create a well-designed delivery system that is practical, achievable and reasonable as well as capable of meeting individual needs and preferences for sub-populations of dual eligibles such as frail elderly, adult physically disabled, or those with chronic mental illness.
Ensure strong beneficiary protections so beneficiaries can retain the protections they currently enjoy under both programs.
Engage consumers in benefit design so that states have a formal avenue for consumer input into in the implementation process.
Assure that combined Medicare/Medicaid funds enhance service delivery Medicare funds should add to, rather than supplant, appropriate Medicaid spending. And coordination across Medicare and Medicaid could help redirect resources from unnecessary hospital and nursing home use to better preventive and primary care as well as home and community-based services and supports.
Establish a culture of quality improvements where states regularly assess health outcomes to continuously improve quality.
“Dual eligibles are a very vulnerable population caught between two public programs that often work at cross purposes because they have separate financing streams and conflicting incentives. States need to chart a deliberate path forward to help these often very sick and fragile Americans maximize the benefits they receive,” said report co-author Karen Davenport, Director of Health Policy at The Center for American Progress.
States facing tight budgets have new avenues through the ACA to assume full financial and programmatic responsibility for managing dual eligibles’ care.
“While integrating Medicare and Medicaid financing can facilitate a high level of coordination among the programs, there are also risks involved,” said report co-author Renée Markus Hodin, Director of the Integrated Care Advocacy Program at Community Catalyst. “A well-designed, well-administered and accountable delivery system is a critical first step to improving quality and efficiency and ensuring that dual eligibles do not face barriers to care.”
To read the full report, click here.
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.