For the under-65 dual-eligible population, nearly half have severe mental disorders, according to a new Health Affairs study. What's more, this group costs nearly twice as much as young dual eligibles without a mental disorder.
The study pulled data from the Medicare Current Beneficiary Survey (MCBS) from 2006 to 2009. The sample of dual eligibles younger than 65 per year was between 1,163 and 1,306; 788 to 883 of those reported having a mental disorder.
Based on this four-year period, average annual health services costs for dual eligibles totaled $20,383, while those with mental disorders spent about $24,155--young dual eligibles with other disabilities spent an average of $12,948. Having both a mental disorder and a functional impairment, like experiencing difficulty with daily activities and having depression, also generated high costs.
Medicare paid for 60 percent of costs incurred by younger dual eligibles with a mental disorder, while Medicaid paid for 23 percent, according to the findings.
Dual eligibles with a mental disorder also had higher hospitalization admittance than those without--25 percent of dual eligibles with a mental disorder visited the hospital in a given year, while 11.5 percent were hospitalized twice or more. Fourteen percent of those without a mental disorder were hospitalized and 4.9 percent went twice or more.
To combat the high costs, the National Commission on Fiscal Responsibility and Reform recommends placing dual eligibles in Medicaid managed care plans that have a budget to reflect and better care for the given population. The recommendation could save a total of $13 billion from 2015 to 2020, according to the report.
Insurers are focusing specific segments of their business on serving dual eligibles, eyeing a huge growth opportunity, FierceHealthPayer previously reported. For example, Minnesota-based UnitedHealth Group hopes to save close to $87 billion over 10 years by using a proposed model of managed care for its dual eligibles, notes the Health Affairs study.
- here's the Health Affairs study abstract