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Chronically Ill and Dually Eligible Populations
Navigating the health care system to get the right care when it’s needed is too frequently an exhausting challenge for some of the costliest, most vulnerable members of our society: those with multiple chronic conditions or disabilities and those who are dually eligible for Medicare and Medicaid. Poorer, sicker, and frailer than most Americans, they face even greater challenges in making their way through the health care labyrinth.
Community Catalyst believes there is a critical need to reform our health delivery system to ensure that these Americans have access to quality care that focuses on their individual needs and prioritizes primary care and prevention. We work to promote public policies that simultaneously improve the quality of care and slow the growth of the costs associated with that care.
- April 16, 2013 Greater Than the Sum: Using Integrated Care to Reduce Racial and Ethnic Disparities among Dual Eligibles This report discusses the dual eligible demonstration projects as an opportunity to address racial and ethnic health disparities among the dual eligible population.
- April 16, 2013 Greater Than the Sum: Using Integrated Care to Reduce Racial and Ethnic Disparities among Dual Eligibles Role for Consumers This guide explains how consumer advocates, particularly those from communities of color, can get involved in shaping these programs to advance health equity.
- March 27, 2013 Risky Business: Capitated Financing in the Dual Eligible Demonstration Projects The national Dual Eligible Demonstration Projects aim to improve health services for lowincome people with disabilities and low-income seniors by moving millions of people and billions of dollars into capitated health plans. The goals are laudable but must be supported by the right financing. Unfortunately, the capitated models under development put health plans at too much financial risk, undermining the goals of the demonstration and jeopardizing the health and well-being of vulnerable people.
- March 27, 2013 The Dual Eligible Demonstration Projects: State and Health Plan Readiness This issue brief summarizes concerns around state and health plan capacity to implement the dual eligible demonstration projects and offers recommendations for evaluating readiness based on what matters most to beneficiaries.
- March 27, 2013 The Dual Eligible Demonstration Projects: The Passive Enrollment Challenge This issue brief explains concerns for affected dual eligible beneficiaries and recommends alternatives to passive enrollment and policy options that might ease beneficiary concerns.
- March 04, 2013 Medicaid Report Card This webtool will help you propose budget-saving alternatives to harmful Medicaid cuts. Just click on your state to get a customized list of policies your state could enact to reduce costs while maintaining or even improving patient care.
- November 30, 2012 Health Homes: Rhode Island’s Development of a Pediatric Health Home Model This paper details the development of Rhode Island's pediatric health home program, which provides coordinated, community-based services to children and youth with special health care needs.
- November 19, 2012 Avenues for Consumer Engagement to Shape Medicaid Managed Long-Term Services and Supports The development of Medicaid Managed long-term services and supports (LTSS) in any state creates openings for consumer engagement. To mitigate the risks and maximize the potential benefits of the program, consumer advocates must get involved when the program is first planned and stay involved as it unfolds.
- November 19, 2012 Executive Summary: Putting Consumers First: Promising Practices for Medicaid Managed Long-Term Services and Supports More states are adopting managed care for the long-term services and supports (LTSS) needed to help Medicaid beneficiaries live with chronic illnesses and disabilities. This guide includes LTSS 101, policy recommendations, promising practices, and tips for engagement to help shape Medicaid managed LTSS to better serve consumers.
- November 19, 2012 Putting Consumers First: Promising Practices for Medicaid Managed Long-Term Services and Supports More states are adopting managed care for the long-term services and supports (LTSS) needed to help Medicaid beneficiaries live with chronic illnesses and disabilities. This guide includes LTSS 101, policy recommendations, promising practices, and tips for engagement to help shape Medicaid managed LTSS to better serve consumers.
- October 05, 2012 Comments to the Center for Medicaid and CHIP Services on Medicaid Managed Long-Term Services and Supports Policies Community Catalyst provides another perspective on some of the recommendations made by the National Association of Medicaid Directors to the Center.
- September 27, 2012 The Case for Protecting Medicaid Medicaid, a program that is more efficient than private insurance, is the wrong place to look for ways to reduce the federal deficit. Cutting the program would not only jeopardize the health of children, seniors and people with disabilities, it would harm state economies that are buoyed by federal Medicaid dollars.
- September 14, 2012 Best Practices for Meaningful Consumer Input in New Health Care Delivery Models This issue brief outlines a framework for thinking about the best practices that are needed to ensure a meaningful consumer voice in new care delivery models.
- July 03, 2012 Letter to Secretary Sebelius Regarding the Dual Demonstration Projects As states have rapidly rolled out their proposals, we have become increasingly concerned that claims of potential savings and/or the speed with which those savings can be achieved is being overstated. In particular, we have three closely related concerns: that savings targets are not yet transparent, that the assumptions on which projected savings are based may be either opaque or overly optimistic and that insufficient safeguards are in place to guard against the potential for either windfall profits or catastrophic losses, either one of which would undermine the goals of the demonstration, and cause harm to people with disabilities and seniors.
- April 10, 2012 Dual Eligible Demonstration Projects: Top Ten Priorities for Consumer Advocates The Affordable Care Act created demonstration projects aimed at integrating care for low-income seniors and people with disabilities who are eligible for Medicare and Medicaid. This issue brief was created to assist advocates in states where duals demonstration project proposals are being created.
- February 22, 2012 Integrated System of Care for Dual Eligibles: Capitated Approach Guidance recently released from the Medicare-Medicaid Coordination Office provides several opportunities to engage in payment models for dual eligibles.
- November 15, 2011 Three Steps to Save Billions of Health Care Dollars This paper outlines Community Catalyst's practical approach to reduce federal health spending on Medicare by providing incentives for quality and efficiency.
- November 03, 2011 Payment Reform Toolkit What if your state could save millions of dollars in its Medicaid program next year and improve patient care? By implementing smart payment reforms, it can.
- October 20, 2011 Shaping Medicaid Managed Care Expansions to Better Serve Consumers Medicaid managed care can provide opportunities for improved coordination, quality, and efficiency of services, but it comes with risks for consumers. This document provides principles to help consumer advocates work for managed care that best serves seniors and people with disabilities.
- July 11, 2011 Letter to Senator Hatch and Representative Upton regarding their Medicaid letter to Governors Community Catalyst and 118 other organizations representing consumers, health care providers, and people of faith in 33 states (plus D.C.) joined together to send an important message to Congress: Don’t shift more Medicaid costs onto states!
- June 06, 2011 Campaign for Better Care Comments Regarding Accountable Care Organizations Community Catalyst is part of CBC, a coalition committed to ensuring that new models of care delivery and payment provide comprehensive, coordinated, patient- and family-centered care while driving down costs.
- December 13, 2010 The "Dual Eligible" Opportunity: Improving Care and Reducing Costs for Individuals Eligible for Medicare and Medicaid As states facing record budget deficits and the federal government look to enact quality and efficiency provisions in the Afforadable Care Act for the 8.8 million Americans enrolled in both Medicare and Medicaid -- or "dual eligibles" -- governments need to take concrete steps to ensure better health outcomes for this population, a Community Catalyst and Center for American Progress report finds.
- April 08, 2010 Chronic Health Conditions Come with a Hefty Price Tag for Patients, Families, and Caregivers Campaign for Better Care's fact sheet outlining what uncoordinated care for chronic illness costs families and caregivers.
- April 08, 2010 Chronic Illness: The Cost to Society This Campaign for Better Care fact sheet outlines how the costs to treat chronic conditions could overwhelm patients, families and caregivers – and strain the health care system. It points out how care coordination improves quality and cuts costs.
- April 08, 2010 Chronic Illness: Who’s at Risk? This Campaign for Better Care fact sheet shows that chronic conditions disproportionately affect older adults and talks about the impact on women, minority and low-income people.
- April 08, 2010 The Case for Better Care: Care coordination for people with complex, multiple health conditions This Campaign for Better Care fact sheet outlines the challenges of care for people with chronic conditions, and makes the case for coordinating care for better results.
- August 31, 2009 Paying for Better Care: A Consumer Advocate’s Reference Guide to Payment Reform Our current method of paying for health care has created a system that is expensive, fragmented, and largely unresponsive patients' needs. It does not emphasize preventive, patient-centered care based on quality outcomes. This brief outlines new payment options as a way to improve patient care and slow the growth of health care spending.
- May 22, 2009 Special Delivery: How Coordinated Care Programs Can Improve Quality and Save Costs This is the fourth in a series of Community Catalyst publications on consumer-friendly options to improve quality and contain costs.
- July 17, 2008 The Medicare Improvements for Patients and Providers Act of 2008: Special Needs Plans On July 15, 2008, Congress voted to override the President’s veto of a broad-ranging Medicare bill that prevented fee reductions to doctors serving Medicare patients. The bill, which is now law, also includes many key safeguards for beneficiaries. Among the law’s many provisions are a number relating to Special Needs Plans (SNPs), a subset of Medicare Advantage plans. The SNP provisions of the Medicare law represent a great step forward in helping to realize the promise of the program. This fact sheet outlines these provisions.
- July 16, 2008 Comments on the Proposed rules for the Medicare Advantage program (CMS-4131-P) Community Catalyst provides proposed changes to Part 422 – Medicare Advantage Program
- June 30, 2008 Medicare Special Needs Plans: A Critical Need for Quality Standards of Care This brief discusses the risk that exists to beneficiaries without a comprehensive set of federal quality guidelines for SNPs. It then highlights best practices for providing quality care through SNPs and suggests standards to ensure that SNP enrollees receive coordinated, integrated care.
- February 29, 2008 Medicare Special Needs Plan: A Consumer Advocate's Guide To Opportunities, Risks and Promising Practices This report provides an easy to read analysis of Special Needs Plans (SNPs)
- November 26, 2007 Medicare Special Needs Plans (SNPs): What Consumer Advocates Should Know About Integrating Medicare and Medicaid Benefits for Dually Eligible Enrollees This brief describes SNPs and the populations they are meant to serve, with a particular emphasis on dually eligible beneficiaries. It then discusses how SNPs, when they are fully integrated with state Medicaid programs, offer the potential to (1) improve the quality of care for beneficiaries with complex care needs; and (2) produce efficiencies that will give state health access advocates a tool to protect or expand state Medicaid benefits for enrollees.
- June 28, 2007 Special Needs Plans (SNPs): Overpayment Debate Ignores Need for Reform to Achieve Original Program Goals This brief describes SNPs and the populations they are meant to serve. It then suggests ways to ensure that SNPs bring high quality care to beneficiaries with complex care needs while also receiving appropriate compensation.
- April 01, 1999 Medicare HMO Marketing and Information: Keeping the Focus on What Consumers Need April 1999 edition of "States of Health"