Improving Care for Dual Eligibles through Innovations in Financing
ABSTRACT Elderly people and younger people with disabilities who are eligible for health coverage through both Medicare and Medicaid ("dual eligibles") are among the sickest and poorest people in the United States. Dual eligibles' extensive needs for medical and long-term care are often complicated by a perplexing and inefficient system of overlapping benefits, skewed incentives for health care providers, and financing fragmented between the federal and state governments. Medicare is the primary payer for dual eligibles and covers services including hospitals, physicians, and prescription drugs; Medicaid covers long-term care and is a secondary payer for Medicare-covered services. About 9.2 million Americans . . .
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ABSTRACT: Pooled data from the 2007, 2009, and 2011/2012 California Health Interview Surveys were used to compare the number of self-reported annual physician visits among 36,808 Medicare beneficiaries ≥65 in insurance groups with differential cost-sharing. Adjusted for adverse selection and a set of health covariates, Medicare fee-for-service (FFS) only beneficiaries had similar physician utilization compared with HMO enrollees but fewer visits compared with those with supplemental (1.04, p = .001) and Medicaid (1.55, p = .003) coverage. FFS only beneficiaries in very good or excellent health had fewer visits compared with those of similar health status with supplemental (1.30, p = .001) or Medicaid coverage (2.15, p = .002). For subpopulations with several chronic conditions, FFS only beneficiaries also had fewer visits compared with beneficiaries with supplemental or Medicaid coverage. Observed differences in utilization may reflect efficient and necessary physician utilization among those with chronic health needs. © The Author(s) 2014.Medical Care Research and Review 12/2014; 72(1). DOI:10.1177/1077558714563169 · 2.57 Impact Factor
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ABSTRACT: Using linked administrative records, we examined expenditure patterns under cash benefit and health insurance programs for 68,794 individuals first eligible for Social Security Disability Insurance (DI) and/or Supplemental Security Income (SSI) in 2000. Expenditures were tracked until death, age 65, or December 31, 2006. Cumulative per capita expenditures averaged US$111,160 in 2006 constant dollars, with 54% incurred under DI, 5% under SSI, and about 20% each under Medicare and Medicaid. SSI and Medicaid expenditures were somewhat higher early on. We concluded that SSI is a relatively low-expenditure program, but it has a major impact on total expenditures by providing access to Medicaid. An important role of SSI and Medicaid is to provide a temporary safety net supporting DI beneficiaries during their DI and Medicare waiting periods. The linkage of expenditure data under these four programs may be useful for evaluating the potential savings of initiatives to encourage individuals with disabilities to remain in the workforce.Journal of Disability Policy Studies 12/2012; 25(2). DOI:10.1177/1044207312469828
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ABSTRACT: People who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category. Medical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression. Of dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care. Attention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs.Preventing chronic disease 09/2013; 10:E157. DOI:10.5888/pcd10.130064 · 1.96 Impact Factor