6 Keys to a Successful Care Management Program for Dual Eligibles

Developing a communication hub is critical to a successful care coordination plan for dual eligibles, says Timothy C. Schwab, MD, FACP, former chief medical officer of SCAN Health Plan. It ensures that all members of the immediate and long-term support team are in sync with each other.

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 that care management programs improve the coordination of care for the Medicare and Medicaid benefits, and can improve overall care of members and their satisfaction. Many programs in many states have presented the relevant data on this.

So the real question then becomes: Can you reduce the cost with these programs overall to the programs? I’d like to refer you to a recent article by Randy Brown, in which he asks the question, ‘Does care management reduce the cost of care for the duals and if so, how and where?’ His article was rather disappointing at best, in that he found very little evidence that supports the argument that this will reduce the overall cost to the two programs.

Brown pointed out two programs that presented literature reducing costs. One was a program operated by SCAN that we’ve had for a long time. He pointed out that there were some weaknesses even in that study, but that it did show that you can reduce the cost. He also pointed out that if you were going to be successful, there were some key elements of the programs you needed to incorporate to make it more likely to be successful.

  • Critical to having a successful care management program is having an in-person contact built in on a regular basis.
  • Second, a link with physicians is critical.
  • Developing patient education is also key, 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.
  • Medication management is critical because so many of these people have a high percentage of medication use.
  • Transitional care is an element that helped reduce the readmission rate.
  • Finally, developing a communication hub so that there’s good communication between caregivers, the interdisciplinary team, and all the providers in the network, whether they’re primary care physicians or specialty physicians, and all the other providers of the long-term services and supports.

Source: Guide to Dual Eligibles Care Coordination

Guide to Dual Eligibles Care Coordination

Guide to Dual Eligibles Care Coordination provides the principles of a comprehensive care coordination effort for Medicare-Medicaid beneficiaries, taking into account the medical, behavioral, social and functional needs of this vulnerable population.

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