What’s Next for Medicare-Medicaid Enrollees?: Findings from the Duals Symposium

Stevenson D
Publication Year: 2019
Patient Need Addressed: Care Coordination/Management
Population Focus: Complex care, Dual eligible
Type of Literature: Grey
link: https://www.healthinnovation.org/resources/publications/findings-from-the-duals-symposium
Abstract

On Nov. 28, 2018, the Center for Consumer Engagement in Health Innovation hosted “The Dual Imperative: What’s Next for Medicare-Medicaid Enrollees.” With support from The Commonwealth Fund, The John A. Hartford Foundation, Peterson Center on Healthcare, The SCAN Foundation and the Valerie Wilbur Health Policy Fellowship Fund, the half-day symposium brought together policymakers, consumers, advocates, researchers and healthcare providers to review lessons learned from the Financial Alignment Initiative (FAI) and to discuss their implications for future integration policies and programs for individuals dually eligible for Medicare and Medicaid.

This report, authored by David Stevenson, presents the key themes that emerged from the day’s discussion and suggests a roadmap of what’s needed to promote a strong future for integrated care for individuals who are dually eligible. Ten recommendations that emerged from the discussion are summarized on the accompanying overview document.

Insights Results

Overview of article

  • In November 2018, the Community Catalyst’s Center for Consumer Engagement in Health Innovation hosted “The Dual Imperative: What’s Next for Medicare-Medicaid Enrollees”. The half-day symposium brought together policymakers, consumers, advocates, researchers, and healthcare providers to review lessons learned from the Financial Alignment Initiative (FAI) and to discuss their implications for future integration policies and programs for individuals dually eligible for Medicare and Medicaid
  • Further context for these discussions was the experience to date of other integration efforts, including the Program for All-Inclusive Care for the Elderly (PACE), Medicare Advantage Special Needs Plans (SNPs), and targeted demonstrations operating outside of the FAI. The following key themes emerged from the day’s discussion and suggest a roadmap to the future of integrated care for individuals who are dual eligible

Results

  • The following key themes emerged from the symposium discussing future integration of policies and programs for individuals dually eligible for Medicare and Medicaid: 1) Emphasis the heterogeneity of individuals who are dually-eligible for Medicare and Medicaid and the importance of keeping real people in mind as programs and policies are considered, developed, and evaluated; 2) Emphasis on optimism and the role of evidence in making sure dual eligible individuals have full access to seamless, high quality healthcare and to make the system as cost-effective as possible; 3) Emphasis on savings through reducing high intensity service use (e.g., keeping people in the community and out of hospitals and nursing homes). Improved care coordination not only aligns generally with individuals’ preferences but can reflect high quality care and produce savings relative to the services individuals would have otherwise received; and 4) Emphasis on the importance of having robust quality assurance mechanisms in place to respond to complaints and pressing concerns as they arise

Key takeaways/implications

  • Moving forward, commitment to measuring their impact on quality of care and the consumer’s experience must remain at the forefront to ensure that efficiency gains do not come at the cost of providing high quality, person-centered care
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