Dual-Eligible Population Accounts for an Estimated $320 Billion in Combined Spending, According to HealthLeaders-InterStudy
May 15, 2012—Nashville, Tenn. —
HealthLeaders-InterStudy, the leading provider of managed care market intelligence, finds that the next wave of growth for health plans will come from states looking to them for experience with coordinated care for high-cost dual eligibles, according to the recently published National MCO Analyzer: Medicaid
report. Dual-eligibles are high-cost patients who qualify for both Medicaid and Medicare benefits. The report finds that, 38 states are currently preparing dual-eligible coordination programs to begin in late 2012 or early 2013. Other states may follow suit.
There are 9 million Americans who are eligible for both Medicare and Medicaid. They include elderly Americans in poverty and severely disabled individuals of all ages who receive their hospital, physician and pharmacy benefits through Medicare, and their long term care services, rehabilitation and other supports through Medicaid. Federal officials hope that coordination of that care will lead to significant savings. This change will shift control of care of this fragile segment to MCOs chosen by the states to administer coordinated benefits. This segment accounts for an estimated $320 billion in combined spending between the Medicaid and Medicare programs.
“This increased care coordination of the dual-eligible segment, and the contracts’ structure and savings requirements will mean that pharma can expect formulary designs to offer broad access to the best medications,” said HealthLeaders-InterStudy Analyst Paula Wade.
In addition to the changes in dual-eligible coverage, states are also taking advantage of new federal funding to establish “healthcare homes” for Medicaid enrollees with chronic illnesses, according to the report. Medicaid MCOs are contracting with hospitals and physician practices that are equipped to coordinate care.
“Medicaid enrollees with chronic illnesses and the non-dual-disabled population are the highest utilizers of Medicaid pharmacy,” said Ms. Wade. “These health homes may improve members’ compliance with drug regimens.”
The coordination for duals is not the only major change for Medicaid plans. Cash-strapped states are cutting optional services, raising cost sharing, trimming Medicaid expansion programs and cutting provider reimbursements.
Members of the media are welcome to attend our upcoming Medicaid Analyst Call entitled: Five Things You Need to Know About Medicaid Now
. The call will be held on June 14th at 2 p.m. EST For more information please contact Kristi Guillemette at email@example.com
The National MCO Analyzer: Medicaid report includes a profile for each state and the District of Columbia to capture each program’s unique structure and operation. An abstract of the report can be found here.