Integrated care coordination for dual eligibles lowers readmission rates in case study

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Dual eligibles in an Arizona integrated coordinated care plan had a 21% lower hospital readmission rate than their counterparts in Medicare fee-for-service programs, a new analysis reveals.

Dual eligibles enrolled in Arizona's Mercy Care Plan, managed by the insurer Aetna, spent 43% fewer days in the hospital than Medicare FFS enrollees; had a 19% shorter hospital length of stays and experienced 9% fewer emergency department visits, according to an analysis conducted by Avalere Health. 

“These results suggest that policy makers should carefully consider some of the existing programs for dual eligibles as promising ways to improve health outcomes while reducing costs for dual eligible beneficiaries,” Avalere Senior Vice President Bonnie Washington said in a statement.

The creation of integrated care coordination programs for dual eligibles — individuals who have extensive healthcare needs and often require skilled nursing care — has been a top priority for the Centers for Medicare & Medicaid Services.

But there has been sharp disagreement over how that care should be integrated, with critics such as the Medicare Payment Advisory Commission arguing against programs such as managed care. Arizona has required Medicaid beneficiaries to enroll in managed care programs since 1982. Mercy Care Plan is a not-for-profit health plan with 340,000 beneficiaries enrolled in Medicare, Medicaid, or both.

Click here for the full Avalere report.

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