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Care Coordination for the Dual Eligible Population

By October 26, 2011Commentary

In the never-ending effort to figure out how to control health spending in our country, one obvious target is the people who have the highest amount of spending associated with their care.  A small minority of patients account for well over half the total national health spending.  Many of those patients are so-called dual eligibles, people who are eligible for Medicare, but also meet the requirements for Medicaid enrollment.  A report from AHIP discusses how the care of those persons might be improved and spending reduced.    (Dual Eligible Paper)

There are over 9 million of these patients with average per person spending in excess of $20,000 in 2010.  These people account for 36% of Medicare and 39% of Medicaid spending.  The federal government alone will spend about $230 billion on these patients in 2011.  Medicaid is the primary budget buster for the states, so reducing spending on these patients is critical.  Over half of these beneficiaries have 5 or more chronic conditions, 42% are hospitalized during a year and 28% spend at least part of the year in a nursing home.  Despite substantial evidence that various team-based programs can help improve care and reduce costs, less than 2% of dual-eligibles are enrolled in such a program.

The key features recommended by the paper for a successful care coordination effort for this population include coordination of care for all needed services with a single capitated payment covering both Medicare and Medicaid, a focus on preventing disease and managing acute episodes, 24 hour availability of a care coordinator, medication management, centralized health records available to all providers and an individualized and integrated care plan supported by all providers.  If all dual eligibles were enrolled in such a program, savings for the state and federal governments would be at least $15 billion a year and likely more.  Given that these patients are supported by the tax dollars of others, enrollment in such a program should be mandatory.


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