Report: Savings of $125B Possible for Coordinating Care of Dual Eligibles

The federal government could save $125 billion over ten years by requiring all people who get both Medicare and Medicaid – dual eligibles – to enroll in team-based coordinated care programs, according to a report written by Emory University’s Kenneth Thorpe and funded by America’s Health Insurance Plans. States could save $34 billion, and the savings would be less at both the federal and state level if dual eligibles were allowed to opt out, Thorpe wrote.

The report comes as the deficit reduction supercommittee contemplates how to save more than $1 trillion. Health care interests, fretting over the prospect of big cuts, are beginning to point members of the committee toward proposals that would save money by creating efficiencies.

This proposal also would improve the quality of care, Thorpe writes. As of 2010, more than 9 million people were eligible for both programs, yet fewer than 2 percent were in coordinated care programs that managed all of their Medicare and Medicaid benefits.

Coordinating their care would save money because dual eligible have high rates of chronic illness. Over half are in treatment for five or more chronic conditions. Some of these conditions, such as diabetes, pulmonary disease and hypertension could be managed with team-based care, which has been successful in reducing hospitalizations, readmissions, and nursing home admissions, he wrote.

Patients might benefit from health coaching and patient education to help them achieve goals set out in personalized care plans. Nutrition, exercise and smoking cessation could be part of the plan, for example.

States could design their own models, and dual eligibles would be automatically enrolled unless they specifically opt out.

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