Abstract
BackgroundIndividuals dually eligible for Medicare and Medicaid coverage are among the sickest patients in the United States. Prior literature has identified a lack of care coordination or even conflicts of interest between the two programs as barriers to more efficient care and better health outcomes among dual-eligibles. The purpose of this study is to assess characteristics of dual eligibles who participated in South Carolina’s 2015 voluntary Medicare-Medicaid financial alignment demonstration project, and to evaluate whether their participation led to better observable health outcomes.MethodsWe obtained all inpatient and emergency department visits, and all Medicaid outpatient visits of individuals identified as Medicare-Medicaid dual eligibles from 2011 to 2016 from South Carolina’s Revenue and Fiscal Affairs Office. We employed logistic regressions to assess the characteristics of participants and quitters in the Medicare-Medicaid financial alignment demonstration project. To evaluate the impact of participation on health outcomes, we used an event study analysis that examines trends in outcomes over time, with participation in the demonstration project as the triggering event, and a difference-in-differences methodology that compares changes in health outcomes before and after participation in the demonstration project compared with a control group.ResultsUrban patients, female patients, and patients with heart problems, social and mental disorders, and importantly, patients with multiple comorbidities (as indicated by a higher Charlson comorbidity index) are less likely to join South Carolina’s demonstration project. Once having joined, female patients and patients with a higher Charlson index appear to be more likely to quit. Those who joined did not appear to enjoy better health outcomes in the short time frame.ConclusionsPolicy makers should explore and address reasons why dual eligibles with complex health problems hesitate to join the alignment project, and continue to monitor whether such a program improves health given that a prolonged period of exposure to the program may be required to achieve better health among the nation’s most vulnerable patients.
Highlights
Introduction to Healthy Connections Prime forProviders [https://www.cms. gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/ Downloads/SCProviderFAQ.pdf]
Our data show that of the 260,325 dual eligibles in South Carolina, only 13,370 individuals ever joined Healthy Connections Prime (HCP)
Patients with several types of individual comorbidities are more likely to enroll in HCP
Summary
Introduction to Healthy Connections Prime forProviders [https://www.cms. gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/ Downloads/SCProviderFAQ.pdf]. The two major sources of public health insurance in the US are Medicare, which primarily covers adults aged 65 and older, and Medicaid, which primarily covers low-income individuals and families.. While most individuals with public health insurance qualify for either Medicare or Medicaid, some qualify for both types of coverage because of old age and low income.. While most individuals with public health insurance qualify for either Medicare or Medicaid, some qualify for both types of coverage because of old age and low income.3 These individual, consisting primarily of the elderly poor and known as dual eligibles, have long been the subject of extensive policy debate because of their poor health, complex health conditions and attendant high costs of care [2, 3]. The combined federal and state expenditures to care for dual eligibles exceeded $306 billion [6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
