Report: Providers should prepare for managed care partnerships for dual-eligibles services

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Care for dual eligibles increasingly will rely on new technologies.
Care for dual eligibles increasingly will rely on new technologies.

Managed care organizations are set to play a bigger role in how long-term care is provided for people currently eligible for both Medicare and Medicaid, and providers should focus on having the right capabilities in place for them, according to a new report. Released by merchant bank TripleTree, it also identifies technology vendors enabling these capabilities in the long-term and post-acute care settings.

Under the Affordable Care Act, the federal government launched demonstration projects to test new ways of coordinating care for those who are dually eligible for Medicare and Medicaid. These projects have been beset by delays and some have been scaled back, but the programs likely will still provide “savings and care benefits” in the long term, report authors state. Beyond these demonstrations, managed care organizations are “perhaps unknowingly” setting the stage for better care for duals, by building out more integrated provider networks.

The 9 million dually eligible beneficiaries account for 27% of total Medicare/Medicaid long-term care expenditures, and 16% of these people live in nursing homes, according to the report. However, to thrive in the future healthcare system, long-term and post-acute providers will need capabilities to care for these residents within larger, integrated care networks, the report authors write.

Providers can expect that managed care organizations will play a larger role in coordinating care for dually eligible beneficiaries through “high-touch” systems, they continue. This might include having workers in the field who conduct in-person meetings with duals and help guide them through the continuum of care.

Prominent voices — including former Vermont Governor Howard Dean (D) — have said that long-term care companies will benefit by expanding their services to include home care, and the TripleTree report concurs. Managed care organizations likely will emphasize care plans for dual-eligibles that involve home care “over a tendency to utilize institutional settings.”

Surveillance technologies also will become more important as a means of tracking whether dual-eligibles are adhering to care plans, the report states. These products will provide more information about the health status of beneficiaries living at home and will help facilitate transitions between settings. Electronic data sharing among payers, providers and caregivers also will be vital moving forward.

Click here to access the complete document, which was released Thursday.