Dual Eligibles
Evaluating California's dual eligible program
June 17, 2016I'm not a person with particularly complex healthcare needs. That said, over the course of my life, I've seen a series of crummy physicians, ranging from those with a poor bedside manner who left me in tears to those who pushed duplicate tests, unnecessary procedures or ill-advised medications.
More than $80 million paid out to Pioneer ACO beneficiaries, report finds
January 05, 2015Nearly $81 million has been made in payments on behalf of beneficiaries in Pioneer accountable care organizations through Sept. 30, a new report finds.
Referrals funnel duals into lower quality nursing homes
July 01, 2014Government health programs could save money and health outcomes could improve if more dual-eligible beneficiaries were to go from hospitals to well-staffed long-term and post-acute facilities, according to research from Brown and Harvard universities.
Lawmakers want pay that is risk-adjusted
July 01, 2014Calculations for Medicare readmissions penalties should be risk-adjusted so that providers do not lose money for serving the sickest, poorest seniors, a group of Congressional lawmakers said in a letter to regulators. Long-term care is carefully monitoring how hospital readmissions penalties are calculated because nursing home reimbursements will be tied to readmissions starting in 2018.
Adjust readmission penalties to protect providers serving dual eligibles, lawmakers urge CMS
June 13, 2014The calculation method for Medicare readmissions penalties should be risk-adjusted so that providers do not lose money for serving the sickest, poorest seniors, a bipartisan group of Congressional lawmakers said in a recent letter to regulators. Long-term care providers are carefully monitoring how hospital readmissions penalties are calculated, because nursing home reimbursements will be tied to readmissions starting in 2018.
Dual eligibles in nursing homes have fewer hospitalizations than those in home- and community-based care, researchers find
March 19, 2014Elderly, frail people are more likely to be hospitalized if they are receiving home- or community-based services than if they live in a nursing home, according to newly published research. Recent Medicaid reforms have aimed to increase use of HCBS because it is believed to be less costly than institutional long-term care, investigators noted. They said their findings suggest that more frequent hospitalizations are a "hidden cost" of home- and community-based care.
Medicaid-only long-term care residents driving up state expenditures, report finds
February 20, 2014Among people eligible for Medicaid but not Medicare, long-term care residents are most likely to be among the costliest beneficiaries for a state, according to a new report from the Government Accountability Office. Sen. Charles Grassley (R-IA) requested the report, noting that much research has focused on those eligible for both Medicaid and Medicare, but has largely overlooked the Medicaid-only group.
Dual eligibles moved out of LTC face risks
February 01, 2014Dual eligibles who move from a long-term care facility to home- and community-based services have a 40% increased risk of a potentially preventable hospital stay.
Transition from facility to home- and community-based care greatly increases dual eligibles' risk of hospitalization, study shows
January 09, 2014Dual eligibles who moved from a long-term care facility to home- and community-based services had a 40% increased risk of a potentially preventable hospital stay, according to recently published research.
The safety net for seniors
January 02, 2014Healthcare reform, especially the expansion of Medicaid, will bring into focus the fragility of the safety net. This is a system that is for vulnerable seniors, but which has not been adequately financed.
Report: Providers should prepare for managed care partnerships for dual-eligibles services
October 21, 2013Managed 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.
Data mandated for dual eligibles outlined as states move to managed care
June 10, 2013Dual eligible managed care plans involved in an upcoming Centers for Medicare & Medicaid Services demonstration project will need to submit data in a variety of areas, the agency explained in a draft statement last week.
States ready for Medicaid managed care expansion, but long-term care remains a worry, report says
May 30, 2013Stakeholders in Medicaid managed care programs feel prepared for the enrollment surge that will follow the full implementation of the Affordable Care Act, but there are ongoing concerns related to long-term care and provider capacity, according to a new report.
State, CMS pair up on duals
April 01, 2013The Centers for Medicare & Medicaid Services and the state of Illinois are teaming up in a dual eligible payment demonstration.
Huge opportunity for dual eligible cost savings, report says
January 11, 2013Better coordination of care for individuals eligible for both Medicare and Medicaid could result in savings of nearly $190 billion by 2022, according to a recent UnitedHealth Center report.
Medicaid underpayments soar to an average $22.34 per resident day, report finds
December 19, 2012The cumulative effect of cuts has been "devastating," AHCA President and CEO Mark Parkinson said.
Senate Finance Chairman accuses long-term care providers of 'gaming' dual-eligible reimbursements
December 17, 2012Long-term care providers struck back quickly late last week after the chairman of the U.S. Senate Finance Committee accused them of "gaming" the reimbursement system during a hearing on caring for individuals eligible for both Medicare and Medicaid.
Managed care experiment for dual-eligibles set to boom; observers worried
December 07, 2012A 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.
Kaiser: Small savings possible in dual-eligible programs
November 02, 2012Attempts to better manage care for "dual-eligible" seniors produced a small savings, according to a study from the Kaiser Family Foundation. The findings show that hopes for a significant decrease in government spending on patients eligible for both Medicare and Medicaid might not be realized.
Increase in dual eligibles under ACA presents opportunity for Medicaid-focused health plans, expert says
October 05, 2012The Affordable Care Act's Medicaid expansion incentives are too attractive for Republican governors to turn down indefinitely, predicted one health policy consultant this week.
Dual-eligibles are happy with Medicare Part D, survey finds
October 04, 2012About 90% of seniors, including dually eligible Medicare and Medicaid beneficiaries, are happy with Medicare's prescription drug program, a new survey reveals.
CMS announces rehospitalization initiative participants
September 28, 2012A new federal program aimed at the reduction of hospitalization among nursing home residents, especially dual eligibles, announced seven health system participants Thursday.
Care coordination demonstration achieves big government savings for dual eligibles: report
September 13, 2012One of the first care coordination demonstration projects for Medicare beneficiaries achieved significant provider savings for dually eligible Medicare and Medicaid beneficiaries, a new analysis found.
Care Coordination Summit to attract providers and other stakeholders to annual conference next Friday
September 07, 2012Long-Term care providers should be more interested than ever in what goes on at a daylong, national summit next week dedicated to improving care coordination. The event takes place Sept. 14 at the National Press Club in Washington. Experts will lead participants through sessions that will cover Accountable Care Organizations (ACOs), improving care for individuals certified under both Medicaid and Medicare, and much more. Experts at the point of care will discuss forward-thinking initiatives and innovative best practices. In less than four weeks, hospitals will begin getting penalized financially for rehospitalization rates that are too high, thus making relationships with long-term care providers more important than ever.
Care Coordination Summit to attract providers and other stakeholders to annual conference next Friday
September 06, 2012Long-Term care providers should be more interested than ever in what goes on at a daylong, national summit next week dedicated to improving care coordination. The event takes place Sept. 14 at the National Press Club in Washington. Experts will lead participants through sessions that will cover Accountable Care Organizations (ACOs), improving care for individuals certified under both Medicaid and Medicare, and much more. Experts at the point of care will discuss forward-thinking initiatives and innovative best practices. In less than four weeks, hospitals will begin getting penalized financially for rehospitalization rates that are too high, thus making relationships with long-term care providers more important than ever.
States should have strong oversight over Medicaid managed care programs, report asserts
August 06, 2012Effective oversight is the key to ensuring access to care for states using managed care organizations for elderly and disabled Medicaid enrollees, a new report suggests.
Integrated care coordination for dual eligibles lowers readmission rates in case study
July 20, 2012Dual 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.
CMS official responds to criticism of pilot programs for dual eligibles
July 19, 2012A federal official defended government demonstration programs that coordinate care for dually eligible Medicare and Medicaid beneficiaries in a Senate hearing Wednesday.
CMS should downsize demonstration programs for dual eligibles, senator says
July 13, 2012Large demonstration programs meant to coordinate the care of dually eligible Medicare and Medicaid beneficiaries could limit access to care and require more thorough testing, critics said this week.
Healthcare expenditures for dual eligibles is double that of Medicare-only beneficiaries, report shows
June 22, 2012Monthly expenditures for individuals eligible for Medicare and Medicaid is nearly two times higher than that of people who receive just Medicare benefits, a new government report finds.
