Care management practices in integrated care models for dual eligibles

Care management practices in integrated care models for dual eligibles

Collection:
Health Policy and Services Research
Series Title(s):
Research report (AARP Public Policy Institute)
Contributor(s):
Burwell, Brian
Saucier, Paul.
Walker, Lina.
AARP (Organization)
Public Policy Institute (AARP (Organization))
Publication:
Washington, D.C. : AARP Public Policy Institute, c2010
Language(s):
English
Format:
Text
Subject(s):
Case Management
Delivery of Health Care, Integrated
Eligibility Determination -- organization & administration
Medicaid
Medicare
Arizona
Massachusetts
United States
Genre(s):
Technical Report
Abstract:
This study examined the care management practices in four health plans that serve persons who are dually eligible for Medicare and Medicaid, commonly referred to as "dual eligibles." The project case studied two health plans in the Massachusetts Senior Care Options program (SCO)--Commonwealth Care Alliance and Senior Whole Health--and two in the Arizona Long Term Care System (ALTCS)--Mercy Care Plan and SCAN Long Term Care. The objective of the study is to understand how health plans operationalize their integrated care management approaches. We are particularly interested in learning how care management is practiced at the point of service delivery. Our goal is to look beyond each state's particular program design and identify common care management practices employed by plans to manage both Medicare- and Medicaid-covered benefits for dual eligibles. We focus on dual eligibles because this group of beneficiaries is particularly susceptible to fragmented care. Compared to persons who are eligible for Medicare only, dual eligibles are much more likely to be in poor health, not have a spouse, have impairments in activities of daily living, have less than a high school education, and suffer from cognitive impairments or mental disorders. The 8.1 million persons who are dual eligibles represent disproportionate spending in both programs. They make up 18 percent of the Medicaid population but represent 46 percent of Medicaid expenditures. In Medicare, they comprise 16 percent of the population but account for 27 percent of all expenditures. Dual eligibles are a prime target for improved care management models. The care management challenges of dual eligibles are magnified by the fact that they receive care from two separate public financing systems, with differing benefits, provider networks, payment incentives, and policy objectives. Many dual eligibles require long-term care services, which are financed under Medicaid, while most of their medical care is financed under Medicare. Medicare and Medicaid services are often provided to dual eligibles through parallel but separate delivery systems with few formal linkages between the two.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
Extent:
vi, 27 p.
Illustrations:
Illustrations
NLM Unique ID:
101546768 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/101546768