In the world of government health care they are called “duals,” elderly or disabled people who have dual eligibility for Medicaid and Medicare coverage.
In Connecticut, spending on “duals” or MMEs (Medicaid Medicare Eligible) as they also are known is the second highest in the nation. The 57,569 Connecticut MMEs represent less than ten percent of Medicaid beneficiaries in Connecticut yet they account for thirty-eight percent of all Medicaid expenditures – in the neighborhood of $2.4 billion annually.
MMEs have complex, health conditions and roughly 88 percent of individuals age 65 and older have at least one chronic disease, while 42 percent have three or more chronic diseases. In addition, 58 percent of younger individuals with disabilities have at least one chronic disease.
Many people who are familiar with the care provider system believe that a lack of coordination drives high spending and also leads to care which can be fragmented, duplicated and delivered in inappropriate settings.
However, the Connecticut Department of Social Services (DSS) has been awarded a federal planning grant to establish a new model of care for MMEs that could dramatically change the situation. The goal is to establish a system that enhances quality of care, while controlling costs.
According to Julia Evans Starr, Executive Director of the Connecticut Commission on Aging the federal grant was “unprecedented. There has never been an effort to look at Medicaid and Medicare” expenditures from the standpoint of better coordination and communication.
The Connecticut proposal was submitted to the federal government at the end of May and if approved could be implemented by the end of this year. It can be viewed on the DSS website but I should warn you it is some 80 pages long so you may want to get an extra large cup of coffee before you delve into it.
The DSS initiative is one of many ongoing federal efforts to coordinate Medicaid and Medicare, which is supported by the Commission on Aging. The commission also is urging the federal and state governments to coordinate all efforts to enhance value, quality and efficiency of care.
DSS has received ongoing input from the Medicaid Medical Assistance Program Oversight Council (which includes CoA) and other stakeholders throughout the planning process. The goal of the proposed model is to center care on the individual with quality of care paramount. Access to care, outcomes and satisfaction will be measured.
Since January, all of Connecticut’s Medicaid enrollees are served by an “administrative services organization” (ASO) that offers certain member and provider services. The model will build on the existing ASO, adding services such as integrated Intensive Care Management and data analytics.
Additionally, “health neighborhoods” – collaborative teams of provider partners including primary care, specialists, hospitals, behavioral health, long-term care facilities, home health and more – will work in partnership with MMEs, their families and caregivers.
MMEs will have access to comprehensive health care, including medical, psychosocial and social support needs. For example, one’s needs may include medication management services, follow-up by nurse practitioners and linkage to transportation and other supports. Most importantly, the model features care integration and coordination.
Spending on Medicare and Medicaid is one of the major driving factors in state and federal government debt. But the amount now spent on these programs is expected to skyrocket as the Baby Boomer generation – which just now is beginning to turn 65 – moves into its 70s, 80s and beyond.
It seems that most of the financial news from the government these days is negative. But every once in a while we get a ray of hope that efforts are underway to get costs in check with out shortchanging America’s most vulnerable citizens. I, for one, am rooting for the Connecticut’s DSS and the Commission on Aging and support their efforts to bring costs under control while improving care.
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