Saying this is "a big breakthrough day," Secretary of Health and Human Services Kathleen Sebelius on Friday announced three efforts she says will help states lower their share of costs for approximately nine million people who are eligible for both Medicare and Medicaid benefits.
These so-called "dual eligibles "make up just 15% of Medicaid beneficiaries but account for almost 40% of the (Medicaid) cost, even though Medicare also pays for part of the care" because these people have significant health needs, Sebelius said. Also, she says, the fact that they must navigate between two separate programs "can make it more likely that they receive fragmented, inefficient, or duplicative care."
Ways to help states lower their share of Medicaid costs are even more important now, as federal subsidies to states from the American Recovery and Investment Act expired as of July 1. "The only way to stabilize Medicaid costs without drastic cuts to eligibility, slashes to benefits, or provider payments is finding ways to slow the growth in spending on patients with the most complex needs."
The three programs include:
- A demonstration project that lets states work with the Centers for Medicare & Medicaid Services work together with health plans to provide comprehensive, coordinated care.
- A program geared to preventing residents of nursing homes from having to be admitted to a hospital. CMS will select nursing facilities that wish to participate in an effort to employ nurse practitioners who would implement best practices to prevent falls, pressure ulcers, urinary tract infections or other events that commonly send nursing home patients to the hospital, but which could be avoided with better care.
- A resource center to help states deliver coordinated healthcare to high-cost beneficiaries. The center will provide technical assistance to states, sharing best practice information or programs that have been effective elsewhere.
Sebelius was joined during her announcement by Washington State Governor Christine Gregoire, who said the 135,000 dual eligibles in her state require $1 billion per year in healthcare costs. Though they represent only 12% of the Medicaid caseload, they account for more than one-third of the spending, she said.
"If we could just reduce the cost of 2% a year by investing in community-based solutions rather than nursing homes, which is what our patients want anyway, by helping them avoid psychiatric hospitalizations, we believe we could save at least $10 million a year just with that small segment – that high-risk segment of our dual eligible population."
"This is our costliest population, with the greatest need, yet we're not able to focus on what's right for them," Gregoire said. "The opportunities you've provided us will make this possible now."
HHS Seeks Comments on Dual-Eligibles