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 Duals Deserve Better, Senate Panel Says

 

 

“Dual eligibles are the most vulnerable of the vulnerable,” said Sen. Herb Kohl (D-Wis.) at a briefing of the Senate Special Committee on Aging, referring to the 9 million seniors who suffer from significant medical and financial struggles and in turn are eligible for both Medicare and Medicaid.

The briefing was spurred by a public letter sent from Sen. Jay Rockefeller (D-W.Va.) to Centers for Medicare & Medicaid Services (CMS) Secretary Kathleen Sebelius, citing his concerns over the Coordinated Care Office’s new Financial Alignment Initiative.

Past efforts to modify the budget and restructure the systems have proven unsuccessful. Improved quality, coordination of care, payment reform, and reduction of duplicity within the Medicare and Medicaid systems were among the key stumbling blocks highlighted by the briefing panels, which consisted of representatives from across the country.

Multiple states have garnered success from their reorganization efforts, according to the hearing’s witnesses. The Medicaid Redesign Team (MRT), based in New York, was one such successful program that, under New York Gov. Andrew Cuomo’s direction, worked in two phases to better address the needs of dual eligibles.

The first phase immediately identified and eliminated $4 billion in unnecessary spending. In order to do so, the MRT opened a line of communication with the public, and “in less than two months, these efforts generated more than 4,000 ideas,” said Jason Helgerson, Medicaid director for the New York State Department of Health, in his testimony.

The MRT devised a comprehensive five-year plan to alter its Medicaid program. Helgerson said that dual eligibles will especially benefit from the MRT’s promotion of Health Homes, which “provide care management for duals [who] don’t require long term care services.”

The program, which begins in January 2013, is projected to benefit some 126,000 dual-eligible enrollees.
Dual eligibles are “real people stuck in broken systems,” said Melanie Bella, director of the CMS Medicare-Medicaid Coordination Office.

CMS recently introduced controversial potential care models targeted at helping 2 million dual eligibles. One area of focus is State Design Contracts, first presented in April 2011 when “CMS awarded 15 states up to $1 million each to design person-centered approaches to coordinate care across primary, acute, behavioral health, prescription drugs, and long-term supports and services for Medicare-Medicaid enrollees,” Bella said.

In addition to cutting costs, all 15 states surveyed concluded that service delivery and payment reforms were necessary.

Bella noted the financial misalignment between Medicare and Medicaid and said that CMS aims to encourage beneficiaries to become engaged in their care and more aware of their options.
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