Thursday, March 5, 2015

How To Provide Care for the Medicare-Medicare Duals: The Population Health Management Playbook

The Care Continuum Alliance (CCA) has come out with an important report on how to improve the care of the 9 million persons who are "dual eligible."  These individuals are among the most economically vulnerable and sickest Americans.  They simultaneously qualify for both Medicare and Medicaid and their health care costs are staggering.

The CCA recommendations for the care of duals on a regional or state basis should not be unfamiliar to regular readers of the Disease Management Care Blog: collect the necessary data, risk-stratify the individuals, maximize coordinated care for those at greatest risk, work with the docs, measure outcomes, lather, rinse repeat.

No knowledge base on disease and population health management and dual eligibles is complete without this download.  Check it out and you'll learn that....

Data on this population should be centralized, comprehensive and interconnected: This means pooling insurance claims, electronic records, labs and pharmacy and making the data available in health information exchanges.  How else will program planners understand the dual's needs, plan programs, foster communication among providers and evaluate outcomes?

The population should be risk stratified.  Health risk assessments are a good option because these persons may drift in and out of dual eligibility.  Incentives should be offered to increase the likelihood that the HRA surveys will be completed.

Professional care planning should be used to to best "position" patients in a coordinated, patient centered and streamlined manner.  This coordination should include providers, pharmacy, behavioral health and long term care to maximize mental health support, rehab, end-of-life care, additional counseling needs and referral to community-based programs.

Provider incentives should use all possible options including capitation, shared savings and bonus payments.  Training and tools should be made available.

Goals for the dual population should be defined and there should be measurement of progress toward those goals.

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