« The Dual Agenda: April 30, 2015 Issue

Noteworthy News

Brief on Prior Experience of States and Health Plans Participating in the Dual-Eligible Demonstrations

The Kaiser Family Foundation released a brief that reviews the prior experience in some of the states participating in the dual eligible demonstrations and in the health plans in operating Medicare Advantage or Medicaid Managed Care (MMC) plans within those states. The brief focuses on the nine states that are undertaking a capitated managed care model (California, Illinois, Massachusetts, Michigan, New York, Ohio, South Carolina, Texas, and Virginia), as well as Minnesota, which is pursuing an administrative alignment demonstration using its existing managed care model. The study finds significant variation in the prior relevant experience that states and health plans are bringing to the table, with a number of states and plans having relatively little experience with managed care that they can translate easily into the demonstration.

Difficulties of Dual Eligible Demonstrations Attract Press Attention

A recent Modern Healthcare article provides a status update on the dual eligible demonstration projects, highlighting problems with enrollment numbers, as well as the anticipated difficulties in achieving the cost savings desired by CMS. The article also identifies a number of other common problems, such as challenges in locating and engaging dually eligible enrollees and resistance from some health care providers to having their patients participate in the demonstrations.

Study Finds Cost Savings in Washington State Chronic Care Management Program

Health Affairs published a study of care coordination services for Medicaid enrollees in Washington State. The study looked at Medicaid enrollees participating in Washington’s Chronic Care Management (CCM) program for clinically complex Medicaid beneficiaries and compared the inpatient hospital costs associated with these patients with those of other clinically complex enrollees who were not in the CCM program. The study found differences in inpatient hospital costs of $318 per member per month, and overall medical savings of $248 per member per month. These results suggest that well-designed targeted care coordination services could reduce health care spending for Medicaid beneficiaries with complex health care needs.

Payment and Delivery Reform Promise and Risks

Families USA has posted a blog about both the promise and the risks that payment reform and health system transformation efforts hold for improving health equity. The key to progress is for advocates to raise health equity issues during the design phase of these programs. The post highlights efforts in Minnesota, where advocates successfully advocated for legislation allowing Community Health Workers to be paid through Medicaid. Community Catalyst published a paper in November, 2014, entitled, “Addressing Health Equity in the Dual Eligible Demonstration Projects” that surveys provisions to promote health equity across the various demonstration states.

Emerging Evidence-Based Models in Social Work

The John A. Hartford Foundation’s ChangeAGEnts initiative shared a research opportunity for social workers to contribute to an effort of The Center for Medicare and Medicaid Innovation (CMMI) at CMS. CMMI is interested in further examining the role of social workers in care delivery and has compiled a number of innovative social work models in a document, "The Impact of Social Work in Emerging Health Care Models."   

There is an opportunity for gerontological social workers who (a) have work they suggest be included in the document    and/or (b) are interested in working with Council on Social Work and Education (CSWE) to expand upon it. There are also opportunities to work with the CMMI regarding data collection on how social work interventions improve care while lowering costs. Interested readers should contact Heather Marshall (HMarshall@cswe.org) with any questions or to express their interest in participating.

Social workers play key roles in effective integrated team-based care – central to the dual eligible demonstration projects.  In general, the inclusion of social workers in health care models has been shown to improve health care and outcomes and to reduce health-associated costs.


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