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.