Dual-eligible pilot program shows promising early results

A pilot project aimed at better aligning care for dual-eligible Medicare and Medicaid beneficiaries has shown promising preliminary results, according to a new government report.

The Washington Health Homes demonstration, which is part of the Medicare-Medicaid Financial Alignment Initiative, was designed to streamline the financing of Medicare and Medicaid while also integrating services for dual-eligible enrollees. States that participate in what's known as a "managed fee-for-service model" can receive performance payments from the Centers for Medicare & Medicaid Services if they meet or achieve savings and quality goals, the report states.

Early estimates for the demonstration in Washington state, which ran from July 2013 to December 2014, show a reduction of $21.6 million in Medicare spending, or a savings of more than 6 percent relative to a comparison group, according to the report.

"While these findings are preliminary, they provide an encouraging first look at how efforts in Washington to improve quality of care by focusing on the needs of high-risk, high-cost members can reduce Medicare spending," CMS Principal Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., wrote in a recent blog post.

In the demonstration, health home care coordinators engaged dual-eligible enrollees to set health action goals, which draw upon records of their past utilization--such as hospitalizations, emergency department visits and specific medication usage--to specify personal actions, interventions and supports needed to achieve the goals, according to the report.

While the pilot program did demonstrate cost savings, "whether these savings have been achieved while improving or maintaining quality of care is not yet known," the report notes, adding that more research is needed to determine the initiative's impact on these factors.

Research has shown that socioeconomic disadvantages often lead dual-eligibles to have poorer health outcomes than the population at large, making this demographic a key target for reform initiatives. Yet CMS has struggled with reaching its enrollment goals for its pilot programs aimed at improving care for Medicaid-Medicare beneficiaries.

To learn more:
- here's the report
- read Conway's blog post

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