Dual Eligibiles have a voice and your quality ratings are at stake. According to the Kaiser Foundation over 9.6 million seniors and younger people with significant disabilities are dually eligible for Medicare and Medicaid programs. Annually, the federal government spends over $300 billion to provide healthcare for dual eligibles. As major consumers of healthcare services, dual eligibles typically represent a chronically ill population that requires care services from several doctors, specialists and home and community service providers. The complexities of their care combined with their social and economic status present a number of challenges. Examples of these chanllenges for health plans include underperforming on quality benchmarks related to NCQA Healthcare Effectiveness Data and Information Set (HEDIS) Scores and CMS Five-Star Ratings. With healthcare reform, policy changes, quality incentives, and rising healthcare costs, health plans should have strategies for improvements to care coordination, communication of benefits and access to services.
Best Practices to Manage Dual Eligibles