Care Coordination for Medicare-Medicaid Dual Eligibles Saves Money

More than nine million seniors are also eligible for Medicaid. So-called dual eligibles consume more than $20,000 in care annually — accounting for 36% of Medicare spending and 39% of Medicaid spending. America’s Health Insurance Plans released a study by Emory University professor Kenneth Thorpe, on the cost savings of better care coordination for seniors who are also eligible for Medicaid benefits. Dual eligible seniors would benefit from a variety of team-based care interventions: These include:

  • Better coordination of care
  • Better medication adherence management
  • Health coaching/ patient education
  • Reducing preventable admissions and readmissions through coordinated transitional care

According to Thorpe:

Assuming States enrolled all dual eligibles into team-based care models, federal savings over the next ten years would total $125 billion—clearly an upper estimate. States would save approximately $34 billion in Medicaid spending over the same ten year period.

Comments (9)

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  1. Devon Herrick says:

    It’s hard to believe there currently is virtually no care coordination between Medicare and Medicaid benefits for dual eligible seniors.

  2. jim says:

    First rule of examining a scientific study — who wrote it, who paid for it. (Does not mean results invalid… but it is science 101).

    Given that AHIP and Thorpe both think that centralized planning is good for hc and their bottom line…

    I am would have been stunned if any other result would have been possible.

  3. Bruce says:

    Managed care works?

  4. Linda Gorman says:

    This isn’t a study, it is a meta-analysis of sorts that really doesn’t show any particular familiarity with Medicaid.

    For the record, in 2009 about 72 percent of Medicaid recipients are in managed care already. It would have been nice to know this. There are about 8.5 million dual eligibles out of a total of 50.4 million. States already operate with special needs plans for dual eligibles. There are other programs like PACE to coordinate care. Why are the results from these not thoroughly examined?

    The question, of course, is whether dual eligibles should be forced into capitated care plans given that many of them are frail and institutionalized. Claims that capitated care plans are better because they decrease expensive hospitalization should be taken with a grain of salt–there is evidence that people leave capitated care plans when they become very ill because those plans make it too difficult to actually access care.

  5. John R. Graham says:

    Agree with Linda Gorman that this is a meta-analysis of sorts, but that is the reality of much of this research.

    I am probably the most pro-managed care of the contributors to this blog. Not that I subscribe to a general theory of managed care, but there’s a truckload of case studies showing its benefits in certain circumstances.

    AHIP’s goal here is to get the government to subscribe to a general theory of managed care, which will certainly backfire.

    On the other hand, surely we cannot think it makes sense for a certain population to be divided between two different payers, one run by the state government and one by the federal government? Surely any co-ordination is likely better than the status quo, no?

    One drawback to all government-run managed-care plans, either Medicaid or Medicare Advantage, is that they contract for one year. Longer term contracts (whtih options for beneficiaries to switch, as per the health-status insurance described by Professor John Cochrane) would be an improvement.

  6. Linda Gorman says:

    John, I disagree that any coordination is better than the status quo. There are all sorts of possibilities that are worse than the status quo. Coordination is often just a code word for limiting individual ability to get the kind of care one wants or needs.

    For example, most coordinated government run systems abroad, and apparently some Medicare managed care groups in Florida, make it difficult for individuals to get joint replacements. The VA is so miserable to deal with that vets who are also eligible for Medicare use it. Medicaid managed care, which is supposedly better because it is coordinated, costs more than fee-for-service. I’m not aware of any data showing that it has better health outcomes.

    We already have coordinated care in the government health programs. Medicaid’s Special Needs Plans are coordinated care. So is PACE which is hugely expensive and serves a vanishingly small segment of Medicare.

    Saying that people should not be divided between two payers–one of which covers acute care, routine care, long term care, drugs, and medical transportation and one of which covers mostly acute care–neglects the fact that there are rules for who pays what that have been worked out between state Medicaid plans and Medicare. If you would really rather have one payer, why would you not embrace single payer, the ultimate coordinator?

  7. eric novack says:

    A goal of trying to find a way to modify utilization– keep the top 5%ish of health care utilizers from making their own ‘preventable errors — would be very helpful — if the top 5% spend about 50% of the dollars (estimated of course), reducing amount of needed spending by even 1% would ‘save’ billions in hc spending system wide.

    Other than on a micro-scale, this has never proven doable… literally hiring live in nurses, cooks, and transportation could make a difference, but would likely be revenue neutral… (that is how much the very top 1% costs)…

    But the reality, of course, is that it not where the money is — it is in taking data and implying that ALL patients would benefit from having their care (i.e. access to care) managed and limited even further than the small amount that this population already uses.

    Since the raw numbers of people x premiums are so big for this group– blocking or limiting broad swaths of care is actually easier and more profitable.

  8. Virginia says:

    We did a case study in class regarding this very issue. The idea was: this patient died of a preventable disease due to problems with care coordination. In our example, the patient was sent home without any follow-up from case workers or others. He simply stopped complying with treatment policies, and eventually died due to complications.

    It was an interesting exercise. We all saw how low-cost outreach would have benefited the patient and saved the system on high-cost, end-of-life treatments. But, at present, there is no incentive to do those things.

  9. John R. Graham says:

    @Linda Gorman:

    I have one (third-party) payer for a car crash or a house fire. I haven’t heard anyone propose that there be auto insurance for different parts of my car or house.

    When I flew to New Orleans a few weeks ago I liked the airplane they gave me, but not the pilot or cabin crew. So, I demanded they switch them. They didn’t do it, so I was outraged at their jamming “co-ordinated” air travel down my throat. I wasn’t thrilled with the brand of jet fuel they used either, but they also refused to switch that.

    I’m not talking about the VA or a government-run system, I’m talking about “co-ordination” or “managed care” in the sense of providers being able to rebundle and reprice their services (as written about often on this blog).

    If nobody accepted managed care then it would not exist. But Kaiser Permanente does fine in all markets in California, including the individual market.