CMS awards dual eligible contracts

WASHINGTON--The Centers for Medicare and Medicaid recently awarded 15 states contracts of up to $1 million each to design new ways to improve and coordinate care for the 9 million people in the country who are beneficiaries of both Medicare and Medicaid.

 

Often among the lowest income and most chronically ill patients in the healthcare system, the so-called dual eligibles represent 16 percent of Medicare members but account for 27 percent of spending in the program, according to CMS. Likewise, 15 percent of all Medicaid beneficiaries are dual eligible and consume 39 percent of the money spent. In all, dual eligible beneficiaries account for more than $300 billion annually across both programs.

 

"Beneficiaries who are in both Medicare and Medicaid can face different benefit plans, different rules for how to get those benefits and potential conflicts in care plans among providers who do not coordinate with each other," said Donald Berwick, MD, administrator of CMS.

 

The work of developing better systems for managing the health of the dual eligible population falls on the newly created Federal Coordinated Care Office, also referred to as the "Duals Office". Created as part of the Affordable Care Act, the Duals Office will work in concert with the Center for Medicare and Medicaid Innovation to help the 15 states develop systems to provide seamless Medicare and Medicaid benefits to dual eligibles.

 

"The overall goal of this contracting opportunity is to identify delivery system and payment integration models that can be rapidly tested and, upon successful demonstration, replicated in other states," Health and Human Services Secretary Kathleen Sebelius said in a letter to House Speaker John Boehner (R-Ohio) describing the work of the Duals Office.

 

 

In Washington, the $1 million grant will be used to fund three phases of a project aimed at better management of the dual eligible population. In the first phase the state will incorporate high-cost dual eligibles into chronic care management programs that already serve other Medicaid clients. The second phase intends to study how Medicaid managed care can better serve dual eligibles, while the final phase will use the information gathered to finalize models and set up integrated, managed care systems for this population, while also analyzing shared-saving opportunities.

 

"This is a major step forward for Washington state and healthcare in general," said Susan Dreyfus, secretary of the Washington State Department of Social and Health Services. "Currently, our systems are fragmented, sometimes limit available services and payment options and are often confusing to the clients themselves."

 

The potential savings for states that can create more integrated and coordinated care management programs for dual eligible beneficiaries are significant.

 

In Michigan, the state estimates 12 percent of the Medicaid enrollment is dual eligible – or approximately 200,000 people. That 12 percent accounted for $3.6 billion of the state's $11.2 billion in Medicaid spending last year.

 

"Integrating care for those who are eligible for both Medicaid and Medicare really is a win-win for our state," said Gov. Rick Snyder in a statement announcing the innovation contract. "Vulnerable recipients will benefit through better coordinated and higher quality care, and Michigan taxpayers will benefit by ensuring resources are spent wisely."