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Dual Eligibles: Best Practices for Managing Your State's Beneficiaries

According to the Henry J. Kaiser Family Foundation, there are roughly 9 million people in the U.S. eligible for both Medicaid and Medicare.
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According to the Henry J. Kaiser Family Foundation, there are roughly 9 million people in the U.S. eligible for both Medicaid and Medicare. These individuals, known as dual eligible beneficiaries or dual eligibles, include people with disabilities of all ages, as well as low-income seniors, whom often have costly and complex health care needs. In a recent webinar, Barbara Selter, a MAXIMUS long-term care expert who has worked with many states on their dual eligible initiatives, spoke about the important lessons she has learned through her experiences.

"We have found that this is a more difficult audience to support," stated Selter. "They have more varied questions and concerns. [And] as the number of elderly and persons with disability grows, and as the cost of care for dual eligibles continues to escalate, states will need a viable strategy for integrating care for the vulnerable and expensive Medicare-Medicaid eligible populations."

As a result of their often costly care, dual eligibles have been a major focus for states and the federal government, with a number of initiatives and proposed projects working to improve quality while reducing costs. One such strategy has been the creation of the Financial Alignment Initiative from the Centers for Medicare and Medicaid Services (CMS), which is designed to better integrate services and align the payment models of Medicare and Medicaid and provide Medicare-Medicaid enrollees with a better overall care experience. As a part of CMS' initiative, states have the ability to propose their own Financial Alignment Demonstrations, which run for three years and propose changes in the care delivery systems through which beneficiaries receive medical and long-term care services. These demonstrations also alter the financing arrangements among the states, CMS and providers.

California was among the handful of states that implemented a dual eligibles demonstration in 2013. As a result of their pioneered demonstration they enrolled more than 120,000 beneficiaries. With its success, California is a great case study for other states that may be looking to implement a similar initiative for their dual eligible population.

Based on our work with nine different state demonstrations, including California, we have complied a list of four steps your state needs to take in order to have the most effective dual eligibles demonstration:

1. Incorporate feedback from all parties as soon as possible
We know that health care language and benefits can be confusing. Make sure that you are clearly defining benefits to both the beneficiaries and providers participating in these programs. Without clear language and broad comprehension, each of these groups will be unable to make the best use of resources. Gaining feedback from stakeholders and the advocacy community is also critical. Make sure the groups communicating to the beneficiary population have collaborated on draft materials and scripts being used to ensure that they are received and understood as desired. It's also important to obtain provider buy-in before beginning communications with beneficiaries to align messages and avoid confusion.

2. Enhance your community outreach
Once you have your messages to the provider and beneficiary community solidified, begin engaging both populations. To effectively reach the beneficiary population, look to conduct local, grassroots events like Town Halls and health fairs where people can learn more and ask questions. For individuals who may not be able to attend in-person events, webinars and outbound call campaigns can be an extremely effective way to get the message out. Also be sure to communicate with providers so they are aware of the benefits of your particular program in your state. Look to conduct telephone interviews and consider providing potential outcome-based incentives for improved care delivery.

3. Improve your overall communications
Health care and health insurance information can be complicated for many beneficiaries attempting to sift though and understand appropriate next steps. When looking to get dual eligibles enrolled in your program be sure that you have well-trained staffed armed with comprehensive telephone scripts and be sure they emphasize the benefits of participating in your program. Notices and fact sheets are two more great ways to communicate with the beneficiary population. When creating those, be sure they are easy to understand, use plain language, and are linguistically and culturally competent. The more synchronized and proactive your communications efforts are, the better the results!

4. Manage your data appropriately
Data needs to be shared across state, federal and vendor channels to ensure aligned care coordination and outreach to beneficiaries. A great first step to take is to work closely with your federal partners to ensure data integrity across state, vendor and federal systems, as well as establish protocols for sharing data with 1-800-MEDICARE. Once established, implementing a comprehensive data reconciliation process is advised to reduce data inconsistencies and avoid beneficiary and provider confusion. Appropriate access to data can also help you measure the health outcomes and efficiencies you achieve through your program.

Dual eligible citizens are an extremely vulnerable population, and meeting their unique needs requires careful design and oversight of new, integrated health care delivery models. These four steps will help streamline efficiency while improving overall care. For more information on California's demonstration, and for additional real-life examples from demonstration projects in other states, click here. To learn more about dual eligible demonstrations across the U.S. and the overall population, visit the Kaiser Family Foundation's website here.