CMS Pilot Program Improves Care for Dual Eligible Older Adults

The Centers for Medicare & Medicaid Services (CMS) recently announced positive results of their pilot program to better serve dually eligible Medicare-Medicaid beneficiaries aged 65 years and older.

CMS is currently partnering with 13 states to implement models of integrated care in order to better align the financing of the two programs and integrate primary, acute, behavioral health, and long-term services and supports for dual enrollees. As a result of the initiative, the number of dually eligible beneficiaries being served in integrated care programs across the country rose from approximately 162,000 to more than 650,000 between 2011 and 2015.

_________________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
CMS Proposal Increases Primary Care Provider Payments in 2017
Copay for Some Brand-Name Drugs Significantly Higher than Generic for Medicare Part D Patients
________________________________________________________________________________________

The Minnesota Senior Health Options (MSHO) program, a collaboration between the US Department of Health and Human Services and the State of Minnesota, aimed to coordinate all of the Medicare and Medicaid benefits that their members receive, including Medicare coverage of acute medical care and Medicaid coverage of long-term services and supports.

In a June 16th post on The CMS Blog, Sean Cavanaugh, CMS deputy administrator and director, Center for Medicare, and his colleagues shared the results of the program. When the experiences of similar beneficiaries from within MSHO and those outside of the program, they found that MSHO enrollees were 48% less likely to have a hospital stay, and 6% less likely to have an outpatient emergency visit. Those who were hospitalized or visited an emergency department had 26% fewer stays and 38% fewer visits, respectively. Additionally, MSHO enrollees were 13% more likely to receive home- and community-based long-term care services.

In the blog post, Cavanaugh and coauthors concluded: “Integrated care is improving the lives of some of the most vulnerable Americans. These new findings from Minnesota affirm the promise of integrated care and reinforce the urgency with which we need to continue to develop, test, and scale successful models for better serving dually eligible individuals.”—Kara Rosania