The Department of Health and Human Services acknowledged that it’s still figuring out how best to controls spending for so-called dual eligibles — individuals who are eligible for both Medicare and Medicaid coverage — during a subcommittee hearing yesterday, but a new study finds that care coordination could provide at least part of the answer. A report from Ken Thorpe of the Partnership of Fight Chronic Disease, shows that the government could save $125.5 billion over 10 years if all dual eligible beneficiaries are enrolled in evidence-based care-coordination models. Dual eligibles comprise 18 percent of Medicaid enrollees but consume 46 percent of total program spending. Similarly, dual eligibles make up 16 percent of Medicare enrollees, but consume 25 percent of total Medicare spending.
Don Taylor has some questions about Thorpe’s proposal, which would shift dual eligibles into private insurance. “I have suggested that dual eligible costs should be federalized (essentially making Medicare responsible for their total cost), with the main point being to put one payer in charge of all their care in order to incentivize cost reduction while increasing quality. Thorpe’s idea would achieve the same general goal using private insurance. There are many relevant details to discuss about Thorpe’s proposal (how would premiums for private plans be set?, what are realistic uptake estimates?, etc.), but it is clear that the current approach to caring for the dual eligibles is wanting both in terms of cost and quality. The only question is what changes should be undertaken to better care for them?