The U.S. Department of Health and Human Services has announced three new initiatives to help states improve the quality and lower the cost of care for "dual eligible" – the approximately nine million Americans who are eligible for both Medicare and Medicaid.
The three separate programs include a demonstration program to test two new financial models in order to better coordinate care for individuals enrolled in Medicare and Medicaid; a demonstration program to help states improve the quality of care for people in nursing homes aimed at reducing hospitalizations; and establishing a technical resource center to help states improve care for high-need high-cost beneficiaries.
"By improving care to the most vulnerable of our citizens, we can improve the quality of their lives and prevent wasteful spending," said HHS Secretary Kathleen Sebelius, in a news release announcing the new programs. "Governors and their staff have been looking for tools to help them accomplish these important goals. I am pleased that we can continue our strong partnership with the states to do this."
[See also: HHS offers states advice on achieving Medicaid savings; CMS awards dual eligible contracts]
The three new programs form HHS are only the latest in the agency's continuing effort to squeeze costs out of the healthcare system by providing better, more coordinated care for the dual eligible population – a group that accounts for more than $300 billion in state and federal healthcare spending each year.
One step in that direction was the creation of the Federal Coordinated Care Office – also known as the "Duals Office" – under the Patient Protection and Affordable Care Act. Earlier this spring, the Centers for Medicare & Medicaid provided grants as large as $1 million to 15 different states to help them develop new methods of delivering and coordinating care for the 9 million people in the country eligible for both Medicare and Medicaid.
One of the specific challenges of caring for this population is they are often among the poorest and sickest people in the healthcare system, with many presenting co-morbidities that make care more complex.
As part of the effort to provide for dual eligibles, HHS is actively working to enroll Medicare-Medicaid beneficiaries in health systems that have made coordination of care a focus of their delivery system. The idea is that better coordination of care will both improve the health of these beneficiaries while making them less frequent consumers of healthcare services.
"These models are designed to address a longstanding barrier to better meeting the needs of some of the most vulnerable Americans we serve," said Donald M. Berwick, MD, CMS administrator, in a prepared statement. "Providing individuals the high-quality care they need, working closely with stakeholders, doctors and state leaders, and ensuring beneficiary protections will be a crucial part of this demonstration."
The dual eligible population accounts for a disproportionate amount of spending by both state and federal governments. Currently, 15 percent of Medicaid enrollees are dual eligible and account for 39 percent of Medicaid spending. In Medicare, they represented 16-percent of enrollees and 27-percent of program expenditures.