America’s Health Insurance Plans (AHIP) says the government has to do a better job of picking the lowest-hanging health reform fruit: Coordinating care for the low-income people who qualify for both Medicare and Medicaid.
AHIP, Washington, is distributing a report by Kenneth Thorpe, a researcher at Emory University, that talks about ways to improve care for “dual eligibles.”
Some dual eligibles are low-income people over age 65; many others are people with disabilities that keep them from working.
Many dual eligibles have two or more serious chronic conditions.
Only about 15% of Medicaid beneficiaries, but they account for about 40% of Medicaid spending, and the Congressional Budget Office predicts the country will spend $3.7 trillion on their care over the next 10 years.
Some states use fee-for-service payment arrangements for dual eligibles; others use managed care health plans. Some are trying to integrate Medicare and Medicaid benefits.
Thorpe suggests on behalf of AHIP that states could take a number of different approaches to improving coverage for the dual eligibles.
But all states should talk to patients and other stakeholders early, apply consistent network adequacy requirements, use uniform methods for measuring quality, create an integrated appeals process, and come up with ways to avoid duplication of services, Thorpe says.
One study suggests that simply preventing 40% of potentially preventable early readmissions to the hospital could save about $100 billion over 10 years while improving patients’ quality of life, Thorpe says.
Doing a better job of coordinating care could save the federal government about $80 billion over 10 years and the states about $45 billion, Thorpe says.
SHOP THE WORLD
The Medical Tourism Association (MTA), West Palm Beach, Fla., is set to start the fourth Medical Tourism & Global Healthcare Congress in Chicago Oct. 25.
The association is hoping government officials who attend a “ministerial roundtable” Oct. 25 will sign a Declaration of Cooperation in International Healthcare.
The MTA also expects to release a set of patients care standards that could be used to develop an International Patient Services Certification Program.
Accreditation agencies already evaluate the quality of care at the facilities used by “medical tourists.” The certification program would focus on giving patients information about the availability and quality of services of interest to patients who are traveling far from home to get care, the MTA says.
The MTA also will be trying to get health insurers to sign a memorandum of understanding that will call for insurers and medical tourism firms to exchange information.
Third-quarter results will be coming out soon, but not all that soon.
UnitedHealth Group Inc., Minnetonka, Minn. (NYSE:UNH), will unveil its earnings Oct. 18.
Earnings season will pick up steam the week starting Oct. 24.
Companies such as Aon Corp., Chicago (NYSE:AON), and Delphi Financial Group Inc., Philadelphia (NYSE:DFG), will report earnings Oct. 24.
WellPoint Inc., Indianapolis (NYSE:WLP) will report Oct. 26, and Aetna Inc., Hartford (NYSE:AET), and MetLife Inc., New York (MET), will report Oct. 27.