Successful care management of dual eligibles, a population that constitutes about 9 million individuals in the United States, presents specific, multiple challenges, explains Timothy C. Schwab, MD, FACP, is chief medical officer of SCAN Health Plan. One key to success is nurturing patient education so members really understand what it means to improve health literacy, what you’re trying to achieve and how they can be part of that.
Care management can tie all this together. The states and federal government are promoting care management as a big part of their solution to increasing budget problems, as an approach to reducing the cost in this population. We know care management programs improve coordination of care for the Medicare and Medicaid beneficiaries, and can improve overall care and satisfaction of members. Many programs in many states have presented relevant data on this.
So the real question then becomes: Can you reduce the cost with these programs overall to the programs? There are five key elements to care management programs you need to incorporate to increase the likelihood of their success.
- First, critical to having a successful care management program is having an in-person contact built in on a regular basis.
- Second, establish a link with physicians.
- Third, develop patient education so that members really understand what it means to improve health literacy, what you’re trying to achieve and how they can be part of that.
- Fourth, incorporate medication management, because so many of these people have a high percentage of medication use.
- Fifth, the practice of transitional care helps to reduce the readmission rate.
- And finally, develop a communication hub so that there’s good communication between caregivers, the interdisciplinary team, and all providers in the network, whether primary care physicians or specialists, and all other providers of long-term services and supports.
Population Health Management for Dual Eligibles: Blueprint for Care Coordination details a unique care management model for duals, which focuses on prevention and early intervention, particularly in the area of medication management.