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Socioeconomic hardships hurt dual eligibles' health outcomes

Issue must be addressed to eliminate health disparities, Inovalon study says

Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid, or "dual eligibles," according to a new study from healthcare analytics firm Inovalon.

Researchers analyzed member-level Medicare Advantage data from several health plans, incorporating numbers from more than 2.2 million members and 364 health plans. They found patients with significant socioeconomic disadvantages, such as dual eligibles, have worse overall health outcomes even after controlling for their health coverage's service quality. If outcomes disparities were driven by care quality, results would have been similar between dual eligible and non-dual eligibles, Paige Reichert, medical senior director of quality at Cigna HealthSpring, which collaborated on the research, said in a statement

Research has come to similar conclusions about the effect of such factors on hospital "frequent fliers," leading to outreach programs in 26 states, run by a combination of state and federal officials, payers and providersFierceHealthcare previously reported.  

"Clearly the issues that are affecting the health outcomes of disadvantaged beneficiaries need to be addressed to eliminate health disparities, and should also be taken into account when measuring the quality of Medicare managed care plans," she added.

The study indicates that the Five-Star Rating System's quality measures don't provide the full picture of dual eligibles' healthcare circumstances, nor do they illustrate the complexity involved in their care needs, Richard Bringewatt, president and chair of SNP Alliance, said in the statement.

In late 2014, 12 states partnered with the Centers for Medicare & Medicaid Services to develop initiatives to improve available resources for dual eligibles' health needsFierceHealthPayer previously reported. Massachusetts has combined the two programs to serve those patients, who comprise 15 percent of Medicaid beneficiaries but nearly 40 percent of overall costs.

To learn more:
- read the study
- here's the statement

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