Dual-eligible programs need stronger quality-of-life measures


Test care models that coordinate benefits for dual-eligibles are lacking in quality-of-life measures, which are essential to identifying effective innovations, concludes a new policy brief from The Commonwealth Fund.

States have been designing and implementing demonstration projects to improve quality and contain costs for the roughly 9 million dual-eligibles.

The Commonwealth Fund looked at quality measures chosen by eight demo states as of December 2013 and found measures that track changes in quality and performance vary from state to state. However, researchers and policymakers need a common set of metrics to compare models of care across states, the authors noted.

Despite great emphasis placed on developing patient-centered demonstrations, participating states and plans have no validated quality-of-life measures for a population with high needs for social and medical services.

Moreover, providers, beneficiary advocates, and state and federal officials all agreed on the need to expand quality measures to make sure duals receive necessary long-term services and support. Even with intentions to enhance access to long-term services and support, the brief found few quality measures to assess home- and community-based services, as well as no patient experience-of-care measures based on an individual's goals and preferences.

Dual-eligibles tend to be less healthy and have more healthcare needs than the Medicare and Medicaid populations in general, prompting states to combine their Medicare and Medicaid programs. And many payers are focusing specific segments of their business on serving dual-eligibles, eyeing a huge growth opportunity.

While the Federation of American Hospitals has expressed concern that the transition is occurring too rapidly, the American Medical Association has adopted new policies to streamline care plans and eliminate conflicting payment rules for Medicare and Medicaid dual-eligibles.

For more:
- read the Commonwealth Fund brief (.pdf)

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