Report: Dual eligible pilots need more oversight

The Centers for Medicare & Medicaid Services needs to strengthen its oversight of care coordination programs for dual-eligible beneficiaries, according to a new report.

In its report, released Tuesday, the U.S. Government Accountability Office encouraged CMS to develop new measures to improve the way the agency assesses dual-eligibles demonstration programs. The programs, currently running in 13 states, are designed to improve care coordination for beneficiaries who qualify for both Medicare and Medicaid.

The state programs reviewed by GAO have state-specific measures to rate care coordination, but they aren't “comparable across the states.”

“Because not all of the information that CMS collects to examine the extent to which care coordination is occurring is comparable, CMS does not fully know whether it has achieved its goal of providing coordinated care to dual-eligible beneficiaries,” the report reads.

The state demonstration programs are part of the Financial Alignment Initiative, a program meant to improve access to care for beneficiaries and reduce healthcare costs. The Medicare and Medicaid programs spent an estimated $300 billion on dual eligibles in 2010, the report noted.

The report recommends CMS establish additional measures to better understand how care coordination is working, and help the agency strengthen oversight of the demonstration. The Department of Health and Human Services responded to the report with proposed actions to improve oversight.