Patrick Administration to Develop Cost-Effective Strategies to Improve Care for Medicaid-Medicare Recipients

BOSTON — The Patrick Administration announced today that Massachusetts has been selected to participate in a new national initiative to improve health care and control costs for individuals who are eligible for both Medicaid and Medicare. Massachusetts will join six other states in developing and implementing strategies to improve care and control costs for these dually eligible members, a high-need population with individual health care costs that are nearly five times those of other Medicare beneficiaries. The Transforming Care for Dual Eligibles initiative is designed by the Center for Health Care Strategies (CHCS) and supported by The Commonwealth Fund.

Announcing the initiative, Secretary of Health and Human Services Dr. JudyAnn Bigby said, “This initiative provides Massachusetts with an important opportunity to help advance the national discussion on fully integrated Medicare and Medicaid systems of care for this unique population, which tends to have lower incomes in combination with more complex care needs than either Medicare- or Medicaid-only beneficiaries.”

Medicaid Director Tom Dehner added, “Although MassHealth’s Senior Care Options and the Program of All Inclusive Care for the Elderly are effective models for integrating Medicare and Medicaid for seniors, it is time to plan for the state’s next generation of integrated care. This initiative will enable Massachusetts to begin discussions with the Centers for Medicare and Medicaid Services about blending financing and member clinical needs in a way that allows MassHealth to ensure truly integrated care for dual eligibles. We’re looking forward to participating in the Transforming Care for Dual Eligibles initiative.

“As we look toward reforming our health care system, there are significant opportunities to improve the quality and cost-effectiveness of care for people who are eligible for both Medicaid and Medicare coverage, whose needs are often overlooked,” said Karen Davis, President of The Commonwealth Fund. “The work of these seven states in designing patient-centered delivery models, if successful, could help pave the way for other states seeking to improve care for these vulnerable beneficiaries.”

Nationally, the more than eight million adults who are dually eligible represent approximately 18% of the Medicaid population, but account for 46% of the program’s costs, due to their complex array of medical, behavioral, and long-term care needs. In Massachusetts, there were approximately 230,000 MassHealth members with dual eligibility in FY08. A majority of dual eligible members are in fragmented fee-for-service systems with little care coordination. Integrating the financing, delivery, and administration of services across Medicaid and Medicare could significantly reduce unnecessary hospitalizations and decrease the use of institutional care over time.

Massachusetts will join Colorado, Maryland, Michigan, Pennsylvania, Texas, and Vermont in seeking to eliminate the barriers to integrating Medicaid- and Medicare-covered services. Through the 18-month program, participating states will receive in-depth technical assistance addressing program design, care models, financing mechanisms, contracting strategies, and working with the federal Centers for Medicare and Medicaid Services.

“With growing momentum, including Congressional interest, for integrating care, it is an ideal time to develop and test new state approaches to improve the quality of care for duals,” said Melanie Bella, Senior Vice President at the Center for Health Care Strategies. “We applaud Massachusetts for its commitment to establish practical and replicable solutions for integrating Medicaid and Medicare and improve care for dual eligibles in the state.”

The Transforming Care for Dual Eligibles initiative continues the work begun by the Centers for Medicare and Medicaid Services and five states under CHCS' earlier Integrated Care Program to address operational hurdles to integrating care by contracting with Medicare Advantage Special Needs Plans. The new program’s goal is to develop a range of integrated delivery models for dual eligibles that can be implemented by other states across the country. Lessons from participating states will be disseminated to Medicaid stakeholders throughout the course of the initiative.

The Commonwealth Fund is a New York-based private foundation supporting independent research on health policy reform and a high performance health system. For more information, visit www.commonwealthfund.org.

The Center for Health Care Strategies (CHCS) is a New Jersey-based nonprofit policy resource center dedicated to improving health care quality for low-income children and adults, people with chronic illnesses and disabilities, frail elders, and racially and ethnically diverse populations experiencing disparities in care. CHCS works with state and federal agencies, health plans, and providers to develop innovative programs that better serve Medicaid beneficiaries. For more information, visit www.chcs.org.

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