Dx For A Careful Approach To Moving Dual-Eligible Beneficiaries Into Managed Care Plans

To coordinate Medicare and Medicaid benefits, multiple states are creating opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicaid plans operated by the same insurer. Tennessee implemented this approach by requiring insurers who offered Medicaid plans to also offer a D-SNP by 2015. Tennessee’s aligned D-SNP participation increased from 7% to 24% of dual-eligible beneficiaries aged 65 years and above between 2011 and 2017. Within a county, a 10-percentage-point increase in aligned D-SNP participation was associated with 0.3 fewer inpatient admissions ( p = .048), 13.9 fewer prescription drugs per month ( p = .048), and 0.3 fewer nursing home users ( p = .06) per 100 dual-eligible beneficiaries aged 65 years and older. Increased aligned plan participation was associated with 0.2 more inpatient admissions ( p = .004) per 100 dual-eligible beneficiaries younger than 65 years. For some dual-eligible beneficiaries, increasing Medicare and Medicaid managed plan alignment has the potential to promote more efficient service use.

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Ohio’s Dual Eligible Population: Effects of Program Design and Implementation on Care Management

Innovation in Aging ◽

10.1093/geroni/igab046.1749 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 453-454

Author(s):

Katherine Abbott ◽

Athena Koumoutzis ◽

Jennifer Heston-Mullins

Keyword(s):

Managed Care ◽

Care Management ◽

Program Design ◽

Service Providers ◽

Coordinated Care ◽

Term Care ◽

Care Plans ◽

Opt Out ◽

Dual Eligible ◽

Documentation Systems

Abstract MyCare Ohio is a prospective blended managed care payment model program tasked to provide comprehensive and coordinated care to Ohio residents who are dully eligible for Medicare and Medicaid. To understand the administration and day-to-day implementation of care management within MyCare Ohio, n=75 interviews with a total of n=331 personnel from Area Agencies on Aging, Managed Care Plans, and service providers were conducted. Interviews were audio recorded, transcribed, and checked for accuracy. Data were analyzed by iterative reviews and deductive coding in Dedoose. Respondents provided insights on how care management activities are affected by program design features (e.g., ability to opt-out of the Medicare component), transitions between acute and long-term care settings, documentation systems and data-sharing, and high numbers of beneficiaries with behavioral health diagnoses. Implications for practice and policy will be discussed.

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Comparing Care for Dual-Eligibles Across Coverage Models: Empirical Evidence From Oregon

Medical Care Research and Review ◽

10.1177/1077558717740206 ◽

2017 ◽

Vol 76 (5) ◽

pp. 661-677 ◽

Cited By ~ 2

Author(s):

Hyunjee Kim ◽

Christina J. Charlesworth ◽

K. John McConnell ◽

Jennifer B. Valentine ◽

David C. Grabowski

Keyword(s):

Managed Care ◽

Financial Incentives ◽

Service Use ◽

Fee For Service ◽

Care Plans ◽

Dual Eligibles ◽

Dual Eligible ◽

Coverage Models ◽

Substantial Heterogeneity

Dual-eligible beneficiaries or “duals” are individuals enrolled in both the Medicare and Medicaid programs. For both Medicare and Medicaid, they may be enrolled in fee-for-service or managed care, creating a mix of possible coverage models. Understanding these different models is essential to improving care for duals. Using All-Payer All-Claims data, we empirically described health service use and quality of care for Oregon duals across five coverage models with different combinations of fee-for-service, managed care, and plan alignment status across Medicare and Medicaid. We found substantial heterogeneity in care across these five coverage models. We also found that duals in plans with aligned financial incentives for Medicare and Medicaid experienced more improvement in their care relative to those with nonaligned Medicare Advantage and Medicaid managed care plans. These results highlight the importance of developing policies that account for the heterogeneity of the dual population and their coverage options.

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Patients Pay Greater Portion of Costs for Substance Abuse and Mental Health Treatment Than for Medical Services in Many Managed Care Plans

PsycEXTRA Dataset ◽

10.1037/e493192006-003 ◽

2003 ◽

Author(s):

Keyword(s):

Mental Health ◽

Substance Abuse ◽

Managed Care ◽

Mental Health Treatment ◽

Medical Services ◽

Health Treatment ◽

Care Plans

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Children with special health care needs in Medicaid managed care plans receive more needed care than those in Medicaid FFS plans

PsycEXTRA Dataset ◽

10.1037/e556332006-034 ◽

2004 ◽

Keyword(s):

Health Care ◽

Managed Care ◽

Special Health Care Needs ◽

Health Care Needs ◽

Care Needs ◽

Medicaid Managed Care ◽

Special Health Care ◽

Care Plans ◽

Special Health

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PMS69 Tumor Necrosis Factor Blocker Dose Escalation among Biologic Naïve Rheumatoid Arthritis (RA) Patients in Commercial Managed Care Plans in the Two Years Following Therapy Initiation

Value in Health ◽

10.1016/j.jval.2012.03.258 ◽

2012 ◽

Vol 15 (4) ◽

pp. A46

Author(s):

M. Bonafede ◽

S.R. Gandra ◽

K.M. Fox ◽

K. Wilson

Keyword(s):

Rheumatoid Arthritis ◽

Tumor Necrosis Factor ◽

Managed Care ◽

Dose Escalation ◽

Tumor Necrosis ◽

Tumor Necrosis Factor Blocker ◽

Care Plans ◽

Therapy Initiation ◽

Necrosis Factor

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Managed Care

PEDIATRICS ◽

10.1542/peds.90.2.278b ◽

1992 ◽

Vol 90 (2) ◽

pp. 278-279

Author(s):

JENIFER D. C. CARTLAND ◽

BETH K. YUDKOWSKY

Keyword(s):

Managed Care ◽

Medical Care ◽

Care Program ◽

Kaiser Permanente ◽

Care Plans

In Reply.— Doctors Sapin and Laws raise fundamental concerns about our article that was recently published in Pediatrics.1 We feel that these concerns are addressed adequately in the paper, but we would like to take this opportunity to clarify our findings. Dr Sapin argues that our study characterizes all managed care plans, such as the Kaiser Permanente Medical Care Program in which he practices, as having ineffective referral mechanisms. He holds that pediatricians at Kaiser experience "no barriers to appropriate referrals" and indicates that we did not stress this finding adequately.

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