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Medicare-Medicaid Coordination for Dual Eligibles: What’s it All About?

Monday, May 13, 2013

Over nine million Americans receive benefits from both Medicare and Medicaid costing over $315 billion in health care services in the two programs combined.  The dual eligibles account for 15 percent of the Medicaid population and almost 40 percent of all Medicaid expenditures for medical services; and 20 percent of the enrollees in Medicare, but 30 percent of the expenditures.

Who are the dual eligibles?  How does the Patient Protection and Affordable Care Act (ACA) address cost and quality of health care issues for this population? What is the office of duals?  What federal initiatives are helping to improve quality, integrate care and align financing?  How are the states involved in serving dual eligibles? In improving their care and coping with the high cost of care?  What do the demos hope to show?
A distinguished panel of experts addressed these and related questions.

Michelle Herman, Center for Healthcare Strategies, provided an overview of the dually eligible population and the major ACA provisions addressing their health care needs.

Greg Moody, Ohio governor’s Office of Health Transformation, highlighted the challenges in Ohio to providing quality care to dual eligibles while managing state budget issues.

Aileen Mc Cormick, WellPoint, discussed the WellPoint care model emphasizing the importance of experience in home and community-based services for care coordination. 

Rodney Whitlock, health policy director for Senator Charles Grassley, brought his experience on the Hill to assess the challenges and opportunities to achieve policy solutions.

Lynda Flowers, AARP Public Policy Institute, provided a consumer perspective on essential consumer protections for people with disabilities and seniors.

Ed Howard of the Alliance moderated the discussion.

This forum took place on Monday, May 13 at the Dirksen Senate Office Building.

The event was sponsored by the nonpartisan Alliance for Health Reform and WellPoint.

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Full Transcript (Adobe Acrobat PDF), 5/13/2013
Full Webcast/Podcast: Full Video

Speaker Presentations

Herman Soper Presentation (Adobe Acrobat PDF), 5/13/2013
Moody Presentation (Adobe Acrobat PDF), 5/13/2013
McCormick Presentation (Adobe Acrobat PDF), 5/13/2013
Flowers Presentation (Adobe Acrobat PDF), 5/13/2013

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 5/13/2013
Speaker Biographies (Adobe Acrobat PDF), , 5/13/2013
Materials list (Adobe Acrobat PDF), , 5/13/2013
Selected Experts List (Adobe Acrobat PDF), , 5/13/2013
Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care (Adobe Acrobat PDF), NEJM, 1/26/2015

Offsite Materials (briefing documents saved on other websites)

Improving Care for Dual Eligibles through Innovations in Financing, The New England Journal of Medicine, 8/31/2011
Risky Business: Capitated Financing in the Dual Eligible Demonstration Projects (Adobe Acrobat PDF),Community Catalyst, Inc, 3/1/2013
Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries (Adobe Acrobat PDF),Kaiser Commission on Medicaid and the Uninsured, 10/1/2012
Medicare Health Plans and Dually Eligible Beneficiaries: Industry Perspectives on the Current and Future Market (Adobe Acrobat PDF),Kaiser Family Foundation, 3/1/2013
Innovations in Integration: State Approaches to Improving Care for Medicare-Medicaid Enrollees., Center for Health Care Strategies, Inc, 2/1/2013
Integrated Care for People with Medicare and Medicaid, National Committee for Quality Assurance, 3/1/2013
Medicare’s Role for Dual Eligible Beneficiaries, Kaiser Family Foundation, 4/1/2013
Realizing the Promise of Integrated Care for the ‘Dual Eligibles, Health Affairs Blog, 10/22/2012
Medicare and Medicaid: Consumer Protection Requirements Affecting Dual-Eligible Beneficiaries Vary across Programs, Payment Systems, and States (Adobe Acrobat PDF),United States Government Accountability Office, 12/1/2012
Dual-Eligibles’ Require New Ideas, Not Cuts, American Enterprise Institute, 7/6/2011
Medicaid’s Role for Dual Eligible Beneficiaries, Kaiser Commission on Medicaid and the Uninsured, 4/1/2012
Data Analysis Brief: Medicare-Medicaid Dual Enrollment from 2006 through 2011, Centers for Medicaid and Medicare Services, 2/1/2013
Dual Eligibles and Integration Efforts (Adobe Acrobat PDF),The Scan Foundation, 4/1/2013
Refocusing Responsibility for Dual Eligibles: Why Medicare Should Take the Lead (Adobe Acrobat PDF),The Robert Wood Johnson Foundation and Urban Institute, 10/1/2012
Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: California, Illinois, Massachusetts, Ohio, and Washington, Kaiser Family Foundation, 5/1/2013
There is Limited Experience and Limited Data to Support Policy Making on Integrated Care for Dual Eligibles, Health Affairs, 6/1/2012
Quality Measurement in Integrated Care for Medicare-Medicaid Enrollees (Adobe Acrobat PDF),Center for Health Care Strategies, Inc, 1/1/2013
The Coming Experiments In Integrating And Coordinating Care For ‘Dual Eligibles (Adobe Acrobat PDF),Health Affairs, 6/1/2013
Report to the Congress: Medicare and the Health Care Delivery System. Chapter 5: Coordinating care for dual-eligible beneficiaries (Adobe Acrobat PDF),Medicare Payment Advisory Commission, 6/1/2011


Medicare and Medicaid pay for different services for those who qualify for both programs, which incentivizes cost shifting, Michelle Herman Soper of the Center for Healthcare Strategies said at a May 13 Alliance briefing, "Medicare-Medicaid Coordination for Dual Eligibles: What's it All About?" (Photo by James Ryder)

In Ohio, dual eligibles are 14 percent of Medicaid patients, but account for 34 percent of costs, Greg Moody of the state's Office of Health Transformation said at a May 13 Alliance briefing, "Medicare-Medicaid Coordination of Dual Eligibles: What's it All About?" Ohio is planning to launch a demo project in the fall to try and lower costs by coordinating care of duals. (Photo by James Ryder)





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