Insurance Executives Recognize Benefits of Integrating Care for Duals

According to a new report from the Kaiser Family Foundation (KFF), the market for managing care for dual eligible beneficiaries, people with both Medicare and Medicaid, is evolving as insurance companies work towards integrating Medicare and Medicaid services. Under provisions in the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) is implementing a multi-state demonstration intended to enhance the quality of care for dually eligible individuals and achieve cost savings in both the Medicare and Medicaid programs. KFF interviewed senior executives at insurance companies in order to assess how these companies view the ability of the demonstration to better coordinate care for dual eligibles and how dual eligible beneficiaries are currently being served by Medicare Advantage (MA) plans.

According to the KFF report, nearly all of the executives interviewed believe the demonstration will have the potential to improve care for dual eligible beneficiaries and create new business opportunities in the dual eligible market. However, they admitted they did have some concerns. Many found development of contracts between CMS, the states and their health plans to be more challenging than expected. They attributed an absence of critical details in these contracts to making it difficult for them to plan ahead or negotiate with providers. And while they felt that the demonstration would potentially bring about savings, they believed it would take time before those savings were fully realized.

Executives of insurance firms with experience delivering both Medicare and Medicaid services admitted that the needs of dual eligible beneficiaries vary substantially, and one insurance plan may not adequately serve all dual eligibles enrolled. According to the KFF report, executives pointed out that older adults with low incomes who qualify for both Medicare and Medicaid have very different needs than beneficiaries who are under 65. And even younger beneficiaries have varying needs—there are different provider networks and management tools necessary for those with mental illness and developmental or physical disabilities.

Dual eligibles are among the most vulnerable people served by both the Medicare and Medicaid programs. Executives interviewed by KFF view the integration of Medicare and Medicaid financing as important to enhancing care for dual-eligible beneficiaries; however, they also state that the initiatives should be designed carefully and implemented thoughtfully due to high risks of failure and lengthy time required for full implementation.