Initiative to test cost-effective approaches for dual eligibles

The Center for Healthcare Strategies is launching "Transforming Care for Dual Eligibles," a state initiative to test innovative care models for people who are eligible for both Medicare and Medicaid.

Colorado, Maryland, Massachusetts, Michigan, Pennsylvania, Texas and Vermont will implement strategies to improve care and control costs for those who are dually eligible – a high-need population with healthcare costs nearly five times those of other Medicare beneficiaries.

"As we look toward reforming our healthcare system, there are significant opportunities to improve the quality and cost-effectiveness of care for people who are eligible for both Medicaid and Medicare coverage," said Karen Davis, president of The Commonwealth Fund. "The work of these seven states in designing patient-centered delivery models for this critical, yet often overlooked, population will help pave the way for other states looking to improve care for duals."

The more than 8 million adults who are dually eligible represent approximately 18 percent of the Medicaid population, but account for 46 percent of the program’s costs due to their complex array of medical, behavioral and long-term care needs. Many are in fragmented fee-for-service systems, with little to no care coordination.

Integrating the financing, delivery and administration of services across Medicaid and Medicare could significantly reduce unnecessary hospitalizations and decrease the use of institutional care over time.

The initiative will work with states to eliminate the barriers to integrating Medicaid- and Medicare-covered services via Medicare Advantage Special Needs Plans (SNPs) and will support the development of alternative models for integration.

Through the 18-month program, participating states will receive technical assistance addressing program design, care models, financing mechanisms and contracting strategies.

"With growing momentum regarding Congressional support for integrating care, it is an ideal time to develop and test new state approaches to improve the quality of care for duals," said Melanie Bella, senior vice president at CHCS. "We look forward to partnering with state and federal policymakers to establish practical and replicable solutions for integrating Medicaid and Medicare."

The Transforming Care initiative continues the work begun by CMS and five states under CHCS' earlier Integrated Care Program to address operational hurdles to integrating care by contracting with SNPs. The new program’s goal is to develop a range of integrated delivery models for those who are dually eligible that can be implemented by other states across the country.