Among Dual Eligibles, Identifying The Highest-Cost Individuals Could Help In Crafting More Targeted And Effective Responses

Abstract

The nearly nine million people who receive Medicare and Medicaid benefits, known as dual eligibles, constitute one of the nation's most vulnerable and costly populations. Several initiatives authorized by the Affordable Care Act are intended to improve the health care delivered to dual eligibles and, at the same time, to achieve greater control of spending growth for the two government programs. We examined the 2007 costs and service use associated with dual eligibles. Although the population is indeed costly, we found nearly 40 percent of dual eligibles had lower average per capita spending than non-dual-eligible Medicare beneficiaries. In addition, we found that about 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending on the dual-eligible population. But even among these high-cost dual eligibles, we found subgroups. For example, fewer than 1 percent of dual eligibles were in high-cost categories for both Medicare and Medicaid. These findings suggest that decision makers should tailor reform initiatives to account for subpopulations of dual eligibles, their costs, and their service use.

Clinical outcomes and resource utilisation in Medicare patients with chronic liver disease: a historical cohort study

“…Our study also showed that younger age was the most important independent predictor of Medicare spending. This is consistent with the fact that younger patients with CLD who qualify for Medicare can only be enrolled due to their disability or other chronic condition such as ESRD 17 18. Furthermore, we expect that the rate of patients with HCV will continue to increase as a result of the CDC's current guidelines which recommend screening all patients between the ages of 45 and 65 regardless of risk factors for HCV 19.…”

Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations

“…1 In particular, MMEs were much more likely to have depression, Alzheimer's disease, diabetes, heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), asthma, or stroke. They account for a disproportionate share of Medicare spending (Coughlin, Waidmann, & Phadera, 2012 (Segal, 2011). This study updates those findings with 2007 to 2009 data, and examines differences in potentially avoidable hospitalization rates by setting, state, and medical condition.…”

High-Cost Dual Eligibles’ Service Use Demonstrates The Need For Supportive And Palliative Models Of Care

“…Care coordination is especially challenging when complex care requires payment from Medicare for medical (acute) services and from Medicaid for long-term services and supports. 9–11 The most widespread new payment models, such as Medicare contracts with accountable care organizations and patient-centered medical homes, have primarily addressed Medicare utilization. But new programs, such as state participation in the Financial Alignment Intiative and Medicare Advantage Special Needs Plans of the Centers for Medicare and Medicaid Services (CMS), are integrating acute and long-term care payment and delivery systems.…”