The status quo is “unacceptable” when dealing with dual eligibles, the head of the Centers for Medicare & Medicaid Services said Thursday.
In a speech to Washington health policy leaders, Administrator Seema Verma said providers must “hold ourselves accountable” for better serving dual eligibles, who are among the costliest beneficiaries in both programs.
“We will challenge ourselves and the states to be better business partners to health plans and providers,” Verma told attendees at the 2018 Medicaid Managed Care Summit in Washington, D.C. “The administrative burdens and inefficiencies to serving dually eligible beneficiaries are unacceptable. It’s time to achieve a level of operational excellence that older Americans deserve.”
Twelve million Americans are eligible for both Medicare and Medicaid. But despite making up 20% of enrollees in Medicare and 15% of Medicaid, they account for about 33% of funding in both programs, she noted.
Improvement stems from better coordination, as less than 10% of duals are enrolled in some form of integrated care, “and instead have to navigate alone across disconnected delivery and payment systems to get the care they need,” she said. “We have to change that.”
Earlier this year, Congress tasked CMS with doing more to promote integrated care for dual eligible. Verma said that work is “well underway,” with the agency planning to support additional states to test out innovative pilot projects that might better serve this population.