Duel-Eligibles' Care Called Big Cost Driver

Abstract

Sharing information and coordinating care for elderly and disabled patients who qualify for both Medicare and Medicaid could save millions of health care dollars every year, according to Health and Human Services department officials. To jump-start efforts in this area, the Medicare-Medicaid Coordination Office – created by the Affordable Care Act – now seeks to provide state Medicaid agencies with access to Medicare data on these so-called “dual eligible” patients. Data on services paid for by Medicare Parts A, B, and D will now be available on a monthly basis and at no cost to state Medicaid agencies, HHS secretary Kathleen Sebelius said at a briefing by the Department of Health and Human Services. “With this new data initiative, we're giving states a fuller picture of the health needs of the people they're serving so they can provide the best care possible,” Ms. Sebelius said. For example, she said, by sharing data on hospitalizations and prescription regimens, physicians and other health care providers can seek to prevent readmissions as well as help to ensure that patients are taking their medications appropriately. In another effort described by the speakers, the coordination office is seeking input on how to best align Medicare and Medicaid to provide both comprehensive and nonduplicative care for beneficiaries with dual eligibility. “These are chronically ill individuals who are old enough to qualify for Medicare and usually poor enough to qualify for Medicaid and [are] in very difficult health situations, but the systems have not talked to each other at all,” Ms. Sebelius said. The office has published a notice for public comment in the Federal Register seeking input about how to align care coordination, prescription drugs, cost-sharing, fee-for-service benefits, enrollment, and appeals between the two care payers. “This is the top priority because it drives the greatest costs, and yet we know if we could work together on this, we could have better health care outcomes for these individuals,” Washington Gov. Christine Gregoire (D), said during the news conference. Even as the federal government works to integrate these programs, some members of Congress are calling for the removal of the Affordable Care Act's Medicaid Maintenance of Effort provision as a cost-saving initiative. Maintenance of Effort requires states to maintain the same Medicaid coverage for adults pending implementation of health reform provisions that go into effect in January 2014. It also maintains coverage for children in Medicaid and the Children's Health Insurance Program (CHIP) through Sept. 30, 2019. In response, Ms. Sebelius said Maintenance of Effort and block grants don't hold the greatest potential for savings. “If the truth be known, the major economic driver for our Medicare costs today … is in the area of dual eligibles,” Ms. Sebelius said. Currently, 9 million Americans are dual eligibles and account for $300 billion in expenditures for Medicare and Medicaid, Dr. Donald Berwick, administrator for the Centers for Medicare and Medicaid Services, said in a statement. Dual eligibles represented 39% of Medicaid spending in 2007, according to a CMS statement. Medicaid spent about $120 billion on this group that year, or approximately twice as much as the program spent on the 29 million children it covered. Frances Correa is a senior writer with Elsevier Global Medical News.