6 Keys to Successful Care Management of Dual Eligibles

Monday, December 10th, 2012
This post was written by Patricia Donovan

Applying a blanket care management approach to all dual eligible populations “is a waste of time and effort,” notes Dr. Timothy Schwab, chief medical officer, SCAN Health Plan.

Instead, care coordination for individuals covered by both Medicare and Medicaid should start with a strong risk stratification program, taking into account the age bands as well as the functional, medical and social status of the population.

Dual eligibles are a diverse group with different longterm-care needs; nationwide, about 40 percent of duals meet ‘nursing home-certifiable’ status, he explains. Additionally, about 35 percent of duals are under 65 years of age, Dr. Schwab said during a recent webinar on Care Coordination for Dual Eligibles: a Results-Oriented Approach. Nearly two-thirds of these duals have only a single chronic condition and no functional impairments.

The federal government has only recently begun to recognize some of duals’ unique needs, he explained. The ACA created both the Office of the Duals and the CMS Innovation Center to pilot new care delivery models.

Operating the only fully integrated dual eligible special needs plan (FIDE SNP) in California, SCAN has a history of successful care management of dual eligibles, who constitute about 9 million individuals in the United States.

The risk stratification should be followed by a very strong multifactorial assessment that goes beyond a traditional medical assessment of a population, followed by the development of individualized care plan, a process that requires buy-in from both the member and the significant caregiver, if one exists, Dr. Schwab states. Goals formulated by an interdisciplinary care team or other stakeholder, a fourth aspect of duals care management, should be meaningful to the member but also realistic to the care manager, Dr. Schwab emphasizes.

There should also be built into care management a reporting feature so that progress toward members’ goals can be tracked and adjusted if necessary.

Finally, inherent in the care management approach should be close attention to the member’s language, cultural norms, and health literacy, as well as their home environment, which impacts everything from a dual’s nutrition to transportation to compliance with care and medical goals.

States already focused dual eligible care management agree that a coordinated approach improves not only care of dual eligibles but also boosts satisfaction in this population, Dr. Schwab relates. However, little evidence has been gathered thus far on cost reductions associated with these efforts, although recent analyses by Avalere Health of SCAN’s care management model demonstrate its effectiveness in reducing readmission rates and inpatient hospital admissions and producing significant cost savings tied to the improvement in health status of members.

Click here for a live audio interview with Dr. Schwab, where he describes the composition of SCAN Health Plan’s Interdisciplinary Care Team for dual eligibles.

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