Managed care experiment for dual-eligibles set to boom; observers worried

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Heart failure patients facing more risks in nursing homes
Heart failure patients facing more risks in nursing homes

A federal experiment for dual-eligibles that hopes to cut Medicaid and Medicare costs through managed care is set to exponentially expand, and some are worried it is destined to fail, according to a report from Kaiser Health News.

"Patient advocates around the country, and some lawmakers in Congress, warn that managed care plans – some run by for-profit, publicly traded companies – are ill-equipped to deal with the complex health needs of those who are elderly, mentally ill or disabled,” Kaiser writers noted.

California is in its second year of its experiment, which was implemented through the Affordable Care Act. Its number of participants will grow to 2 million in the coming months. Twenty-five other states have applied for inclusion. Patients in the plan include those whose care is the most expensive.

Stakeholders are anxious to see how the shift from traditional fee-based care will fare. Health officials say they think quality will improve while cutting back on unneeded or duplicated office visits, hospitalizations and tests.

Skeptics of the program and its implementation see many problems. They include: patients losing contact with existing physicians, providers without needed specialists on the staff and an opt-out for the program that may be too complex to navigate.

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