ACO study reflects cost savings and reduced readmissions

September 17, 2012 | Erin McCann – Contributing Writer and Associate Editor for Healthcare IT News

 

Accountable care organizations (ACOs) can deliver cost savings and reduce readmission rates, according to a recent study from the Dartmouth Institute for Health Policy and Clinical Practice

The study, published in the Sept. 12 issue of The Journal of the American Medical Association, examined the cost savings associated with the Physician Group Practice Demonstration (PGPD), a Medicare program that ran from 2005 to 2010 and closely resembled current ACOs.

Study analysis pegged the overall annual savings from this value-based payment model at $114 per Medicare beneficiary, and the overall annual savings for duallyeligible populations  –  that is, patients who qualify for both Medicare and Medicaid  –  at $532 per beneficiary.

 

Report authors said the cost component findings are significant, as the nation’s 9million dual eligibles comprise 20 percent of the Medicare population but account for 31 percent of its spending, and comprise 15 percent of the Medicaid population but 39 percent of its spending.

Readmission rates were also affected in the demonstration, with 30-day medical readmission rates decreasing 0.67 percent overall for both populations, and 1.07 percent for dually eligible beneficiaries. Moreover, surgical readmissions for dually eligible populations decreased 2.21 percent overall. With 990,117 Medicare and/or Medicaid beneficiaries included in the experimental group, and 7,514,453 beneficiaries in the control group, report authors noted that these numbers are statistically significant.

“The study shows promise for the new healthcare delivery system reforms,” said Carrie H. Colla, lead author of the study and assistant professor at The Dartmouth Institute for Health Policy and Clinical Practice. “And these reforms should align incentives for payers, providers and patients.”

Colla pointed out that the study was done to examine the cost savings benefits of a value-based ACO program, and the PGPD was a near perfect match.  “I would say the two fundamental characteristics of the ACO-type contract are pay-for-performance and shared savings,” said Colla. The PGPD and the new Medicare ACO contracts include both these things, she added, and the quality metrics are very similar. 

Physician groups participating in the demonstration could receive up to 80 percent ofsavings they generated. In the new ACO programs, savings are generally lower, between 50 to 70 percent.

Out of 10 participating physician groups, the University of Michigan Faculty Group Practice saved the most money, averaging out to $866 per person, per year for both populations. When examining the dually eligible patients, the practice’s savings were more marked, pegged at $2,499 per person, per year.

The Middletown, Conn.-based Middlesex Health System saw the least savings all around, actually expending $749 per beneficiary for both populations and $598 for the dually eligible.?As far as non-dually eligible beneficiaries, PGPD savings were not as substantial, with some organizations seeing savings of only $59 per person, per year. However, some organizations, such as Wisconsin’s Marshfield Clinic and the University of Michigan Faculty Group Practice, observed savings of more than $500 per patient, per year for non-dually eligible beneficiaries.

Colla emphasized the significant cost and readmission improvements for the duallyeligible population. She said the study results are “a marker for populations that have higher rates of chronic disease,” and really show that “ACOs have the potential to improve healthcare and reduce spending for [the dually eligible] population.”

Overall, Colla said the study supports value-based healthcare for certain groups and can have a marked effect on complex patients in the system.

“The current fee-for-service payment system has contributed to the fragmented, poorly coordinated care that many patients, especially those who are sick, experience every day,” said Elliott S. Fisher, MD, report author and co-principal investigator of the Dartmouth Atlas Project in a Dartmouth press release. “New payment models like ACOs are intended to encourage providers to coordinate care by offering them a share of any savings achieved when they improve care. These results indicate that when organizations really try to adapt to these new models, they can benefit their patients’ lives and theirbottom lines.”

 

Source:

http://www.physbiztech.com/news/aco-study-reflects-cost-savings-and-reduced-readmissions

Dual-eligibles market creates opportunities for physician practices

The managed care market for the Medicare-Medicaid population could range from $86 billion to $183 billion in the next five years, Booz & Co. estimates.

By JENNIFER LUBELL, amednews staff. Posted Sept. 14, 2012. 

Washington- Physicians have new opportunities to partner with health plans to take advantage of the rapidly growing private market for beneficiaries who are eligible for both Medicare and Medicaid, according to a partner at a global management consulting firm.

“There’s been a tremendous interest and appetite around the so-called dual-eligibles population,” said Sanjay Saxena, MD, a partner in the North American health practice at Booz & Co. and co-author of a new Booz report (booz.com/media/uploads/BoozCo_Winning_ in_the_Medicaid_and_Duals_Markets.pdf).

Several years ago, discussions about changes in the private insurance market were all about health insurance exchanges, then about accountable care organizations, and “now it’s about the duals,” Dr. Saxena said.

The Booz report discusses ways in which managed care companies could leverage both the Medicaid and dual-eligibles markets by identifying states that present the best growth opportunities and then defining their operating models or “choosing a way to play” in these markets. Managed care organizations, for example, could enable care delivery by supporting or delegating care management activities to medical groups or hospitals, or going so far as to own or manage networks of hospitals or physician groups in an effort to integrate care management and create incentives to drive care coordination.

As managed care organizations engage in these models, physician groups also should think about how they want to participate in the growing Medicaid and dual-eligibles marketplaces, Dr. Saxena said. He said some medical groups may be proactive and well-positioned enough to reach out to health plans and say, “Look, we build medical homes, we have care coordinators, and have the kind of outreach and relationships with the community where wefeel we could share in the incentives and savings and benefits and high-quality care.”

As high utilizers of care, dual-eligibles have complex health needs and rack up roughly $300 billion in costs annually to Medicare and Medicaid. These challenges notwithstanding, many health plans have been viewing government-subsidized markets as very attractive opportunities, Dr. Saxena said. “For physicians, whether we like it or not, those are the markets that continue to grow in size.” In looking at future avenues for growth, analysts have seen that employer-sponsored insurance markets have been declining steadily, and while the individual market is expected to expand through theAffordable Care Act’s insurance exchanges, that’s going to be a difficult market to navigate as well, he said.

WellPoint’s recent acquisition of AmeriGroup and Aetna’s purchase of Coventry Health Care are two developments that illustrate a growing interest in Medicare and Medicaid managed care, Dr. Saxena said. InAetna’s case, “the major driver was greater exposure in the government market. For WellPoint and AmeriGroup, it’s a very similar story.” WellPoint and its competitors have shown recent interest in managing care for the dual-eligible population.

The health system reform law’s expansion of Medicaid, moves by states toward Medicaid managed care to get budgets under control, and a series of new federal demonstration projects that aim to find more efficient ways to manage the dual-eligible population “are three separate but related things that are creating this opportunity,” Dr. Saxena said. During the next five years, Booz & Co. estimates that the managed care market size for dual-eligibles alone could range from $86 billion to $183 billion.

http://www.ama-assn.org/amednews/2012/09/10/gvse0914.htm

Copyright 2012 American Medical Association. All rights reserved.

The National Dual Eligibles Summit

Dual Eligibles Summit Publications Printing Dept.

The nine million dual eligibles who qualify for both Medicare and Medicaid benefits make up one of the country’s most vulnerable populations. Beneficiaries frequently encounter barriers to healthcare access and have great difficulty navigating the complex administrative system created by the uncoordinated and often conflicting incentives of two beneficiary programs. The Affordable Care Act contains several provisions intended to improve the quality of care delivered to dual eligibles, while gaining greater control over the increasing costs of caring for this population by offering high quality coordinated care and improved outcomes. The First National Dual Eligibles Summit, October 30 – 31, 2012 in Los Angeles, will bring together policymakers, state government officials, advocates, experts, and caregivers who have been working on the front lines, providing care and advocating for the dual eligible population. Featured speakers and expert panels will provide analysis and perspective, and will share their hands-on experience in caring for this unique population. The two-day conference will include in-depth discussions of a number of different state demonstra- tions, plan and provider alignment strategies, the implications of the upcoming elections, and the long-term impact of health reform. In addition to compelling keynote presentations, there will be two content-rich pre-conferences and fifteen concurrent sessions offering participants a chance to discuss the implementation and operational challenges involved in managing care for dual eligibles, quality measurement, innovations in home and community based services, network strategies, and risk management. Please join us in discussing this urgent initiative with thought leaders, colleagues and national policy and program experts.

National Dual Eligibles Summit takes place on October 30 – 31, 2012

Beverly Hilton Hotel  Los Angeles, CA

Who Should Attend:

  • ExecutivesandBoardMembers
    of Health Plans, Health Systems, Hospitals and Physician Organizations
  • MedicalDirectors
  • Physicians
  • Nurses,NursePractitionersand

Other Allied Health Professionals

  • PharmacistsandPharmacy

Benefit Managers

  • RepresentativesofPurchasers,including

Private Employers and Public Purchasers

  • ConsumerOrganizationRepresentatives
  • FederalandStateGovernmentOfficials
  • HealthCareRegulatorsandPolicyMakers
  • HealthBenefitsConsultants
  • HealthServicesResearchers

and Academics

  • HealthCareAttorneys

and In-house Counsel

  • ChiefFinancialOfficers
  • ChiefInnovationOfficers
  • DirectorsofAccountableCare
  • DirectorsofQuality

Management and Improvement

  • DirectorsofGovernmentPrograms
  • DirectorsofMedicarePrograms
  • DirectorsofMedicaidPrograms
  • DirectorsofNetworkContracting
  • DirectorsofProviderRelations
  • DirectorsofFinanceandReimbursement
  • PharmaceuticalExecutives
  • PharmaceuticalConsultants 

CAPG and IHA WELCOME

As Dual Eligibles Summit co producers, it is the pleasure of the California Association of Physician Groups (CAPG) and the Integrated Healthcare Association (IHA) to welcome attendees to our Dual Eligibles Summit. The Summit will provide an unprecedented opportunity to discuss, dissect, and identify the best managment methods for the care and cost of Medicare/Medicaid Dual Eligibles.

 

Donald H. Crane, JD,

President and Chief Executive Officer, California Association of Physician Groups

Tom Williams, DrPH,

President and Chief Executive Officer, Integrated Healthcare Association 

Source: http://www.dualeligiblessummit.com/brochure/DualEligibles2012.pdf 

Dual-Eligible Demonstrations Push Forward After Court Ruling

From Governing.org

BY: | August 1, 2012

While they haven’t attracted the amount of press, or federal dollars, as the Medicaid expansion or state health insurance exchanges, the dual-eligible demonstration projects under the Affordable Care Act (ACA) also hung in the balance while the law’s constitutionality remained uncertain. So with the Supreme Court’s decision to uphold the federal health care reform law—and a pending deadline in September—states that have gotten a head start on the projects know that a year-plus of planning will not go to waste.

At the beginning of 2011, the U.S. Department of Health and Human Services (HHS) awarded $1 million planning grants to 15 states. The money was intended to help states develop ideas on how they can better manage dual-eligibles: the poor elderly who qualify for both Medicare and Medicaid. The goal is to both provide better care by improving coordination between Medicare (which is federal-run) and Medicaid (which is state-run) and, by doing so, cut costs.

How big is the dual-eligible issue? According to federal estimates, dual-eligibles comprise 15 percent of Medicaid enrollment, but account for 39 percent of its spending. They also make up a disproportionate amount of Medicare spending. The problem is that, because the programs are run separately by the federal government and the states, there isn’t always communication between the two, even though they’re together covering one individual.

Broadly speaking, Medicare covers acute incidents (such as a trip to the emergency room) while Medicaid covers long-term care (such as nursing home residency). But, in action, the lines aren’t so clearly drawn. Reports have circled for years about the offices bickering over which would pay for which services for an individual. The Wall Street Journal last year recounted the story of a quadriplegic who was forced to stay in a rehabilitation facility for six months while the two programs argued over which would be responsible for covering his home-based care.

“It’s a national shame that we are subjecting the poorest and sickest among us to this fragmented care,” said Matt Salo, executive director of the National Association of Medicaid Directors, at a Health Affairs conference last month.

The ACA aimed to address the dual-eligible problem through two offices created by the law: the Federal Coordinated Health Care Office (colloquially called the Duals office) and the Center for Medicare and Medicaid Innovation, which would together oversee the state demonstrations. The Duals office authorized the 15 $1 million planning grants, and a total of 26 states have stated their intention to undertake demonstration projects. Strategies for improvement include moving dual-eligibles into managed-care systems or focusing on specific populations (such as nursing home residents) who commonly have issues in coordinating care.

States that want to begin their demonstrations in 2013 must finalized their plans by Sept. 20, according to an April presentation by the Medicare Payment Advisory Commision (MedPac). About half are expected to do so; the remainder will launch their demonstrations in 2014. To prepare for that deadline, MedPac projected that states would have to submit their initial proposals and seek public comment in the spring, then meet with health-care providers in June to get their input.

The initial constitutional challenge to the ACA was filed the day after President Barack Obama signed it into law—which means almost most all duals demonstration planning so far took place under the air of uncertainty that ended on June 28, when the Court issued its decision to, in effect, uphold the entire law.

While overturning the ACA would have invalidated the Duals offices and their funding, the dual-eligible issue would still have needed to be addressed, as spending for Medicaid and Medicare is projected to crescendo in the coming decades. The only option, state officials say, was to push forward despite the lack of assurance about the law’s fate. 

“The issue isn’t going to go away. It’s only going to increase in terms of the pressure it puts on the health-care system,” says Patti Killingsworth, assistant commissioner at TennCare, Tennessee’s Medicaid office, who oversees long-term care services and her state’s demonstration project. “So, what we said in our planning process is: we are going to find a way to improve the coordination of care for dual-eligibles regardless of the authority that we use.”

Given the amount of work that states had done over the last year, some would likely have pushed on with their plans regardless of the Court’s ruling. But knowing that they’ll have the full resources outlined in the ACA is reassuring, state officials say. For starters, the Duals office is expected to facilitate data sharing across the two programs, a key component to improvement that has been missing in the past.

“We were committed to serving this population regardless. What this enables us to do is to do it better and smarter,” says Denise Levis at Community Care of North Carolina, which is overseeing that state’s demonstration project. “Everyone’s agreed that things need to change. But we were a little anxious, so it was a relief.”

 

This article was printed from: http://www.governing.com/blogs/view/gov-dual-eligible-demonstrations-push-forward-after-court-

Improving care for dual eligibles could lower rehospitalizations, study finds

McKnight’s Long Term care

June 18, 2012

 

 More focused treatment of common illnesses among dually eligible Medicare and Medicaid beneficiaries could cut costs and lower hospital readmissions, researchers found.

In analyzing data from 958,837 hospitalizations of residents of Medicare and Medicaid-covered nursing facilities and Medicaid home- and community-based services waiver programs in 2005, investigators found that 39% of admissions might have been avoided with more effective care.

Conditions including pneumonia, congestive heart failure, urinary tract infection, dehydration and chronic obstructive pulmonary disease or asthma were to blame for three-quarters of these admissions, researchers noted.

Interventions that improve long-term care settings and expand home and community-based service programs, “will require additional investments by state Medicaid programs to yield savings or Medicare policies that provide an incentive to reduce hospitalizations,” Edith Walsh, Ph.D., lead author of the study, said.

The study was published in the May issue of the Journal of the American Geriatrics Society.

Report IDs states with most, least dual eligibles

The Daily Briefing

Report IDs states with most, least dual eligibles

Maine, Alabama have the largest percentage of dual eligibles as a share of Medicaid

May 30, 2012

Eastern states have higher percentages of “dual eligible” patients as a share of Medicaid than Western and Midwestern states, according to a new Kaiser Family Foundation report.

Altogether, about nine million U.S. residents and more than 15% of all U.S. Medicaid beneficiaries are eligible for both the Medicare and Medicaid program.

To determine the geographic distribution of these “dual eligibles,” the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute analyzed Medicaid Statistical Information Statistics data from fiscal year 2008.

Related: The Advisory Board’s primer on new efforts to coordinate care for dual eligibles.

The report found that the 10 states with the highest percentages of dual eligibles as a share of total Medicaid enrollment were:

1. Maine (where 26% of Medicaid beneficiaries are dual eligibles);
2. Alabama (23%);
3. North Dakota (22%);
4. Kentucky (21%);
4. New Jersey (21%);
4. Wisconsin (21%);
7. Florida (20%);
7. Mississippi (20%);
7. Rhode Island (20%); and
7. West Virginia (20%). 

Meanwhile, the 13 states with lowest percentages of all dual eligibles as a share of total Medicaid enrollment were:

1. Arizona (where 10% of Medicaid beneficiaries are dual eligibles);
1. Utah (10%);
3. Alaska (11%);
3. California (11%);
3. New Mexico (11%);
6. Delaware (12%);
6. Colorado (12%);
8. District of Columbia (13%);
8. Illinois (13%);
8. Michigan (13%);
8. Washington (13%); and
8. Wyoming (13%).

A state-by-state map of dual eligibles as a share of total Medicaid enrollment

According to the report, “these variations reflect a state’s demographic profile as well as state policy choices in Medicaid eligibility and coverage.” For example, the report notes that Eastern states generally have larger elderly populations than Western and Midwestern states.

Kaiser notes that 26 states have submitted proposals to test integrated care models for dual eligibles under a three-year, multi-state demonstration project (Kaiser report, 5/24; AHA News, 5/25).

Kaiser Health News Digest – Dual Eligibles

States Push Feds To Include 3 Million ‘Dual Eligibles’ In Pilot Program

May 08, 2012

Though only designed for 2 million beneficiaries, states want the federal government to open a pilot program on dual eligibles — those who qualify for both Medicare and Medicaid — to 3 million. In the meantime, California is shifting its dual eligibles to managed care.

Modern Healthcare: Dual-Eligibles Pilot Program Faces Rush From States
States want to include more than 3 million dual-eligible beneficiaries in a CMS pilot program to overhaul their care and payments.  The number is 1 million more than the program was designed for and represents about a third of all that category’s beneficiaries, whose care is one of the biggest drivers of the growth in Medicaid costs (Daly, 5/7).

California Healthline: Risks, Rewards Higher for Managing Dual Eligibles 
The state is working to shift older, low-income Californians eligible to receive Medi-Cal and Medicare — known as dual eligibles — into managed care plans, hoping to coordinate and improve care, as well as save money. The state also is shifting Medi-Cal beneficiaries participating in the Multi-Purpose Senior Services Program into managed care. … About 60 percent of the 7.6 million people covered by Medi-Cal are in managed care plans. … The most-expensive Medi-Cal beneficiaries, many of them older with multiple chronic conditions, are still in fee-for-service plans (Lauer, 5/7).

Less Than 1% of Dual Eligibles Considered “High-Cost” Beneficiaries

From Becker’s Hospital Blog
 
Written by Bob Herman | April 19, 2012

 

There are roughly 9 million people who are beneficiaries of both Medicare and Medicaid — also known as dual eligibles — and although it is a costly population, less than 1 percent of dual eligibles are considered to be in “high-cost” categories, according to a recent study in Health Affairs.

The authors looked at the 2007 Medicare Current Beneficiary Survey and the 2007 Medicaid Statistical Information System Summary File for their base of data, and they only focused on public spending of dual eligibles.

The combined average per capita spending on dual eligibles was $29,868 in 2007 — more than four times the per capita spending for non-dual-eligible Medicare beneficiaries. However, these results are averages, and the authors found that not all dual eligibles are “high-cost.”

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In 2007, they found roughly 40 percent of dual eligibles had combined Medicaid and Medicare annual spending that was less than the average $7,226 per capita Medicare costs on non-dual-eligible Medicare beneficiaries.

The study’s authors also found that only a relatively small portion of dual eligibles was responsible for the majority of the population’s total spending, as is the case for healthcare in general. Roughly 80,000 dual eligibles, or less than 1 percent of all dual eligible beneficiaries, were in the highest 10 percent of the spending distribution in both Medicaid and Medicare.

“It is these high-cost dual eligibles who would particularly benefit from initiatives aimed at coordinating care and aligning incentives between the two programs,” according to the report. “That said, high-cost Medicare-Medicaid dual eligibles accounted for only about 4.6 percent of total spending on the population in 2007.”

Resistance builds to managed care for dual eligibles

Physicians are speaking out as states look to a vulnerable and expensive population of patients as a target of budget cuts.

By Emily Berry, amednews staff. Posted April 9, 2012.

IOphthalmologist Victor Gonzalez, MD, stood in front of a crowd of hundreds of physicians and patients in McAllen, Texas, and spoke in stark terms about what is happening as the state changes and cuts coverage for dual-eligible patients: those old or disabled enough for Medicare, and poor enough for Medicaid.

A move to put those 320,000 patients in Medicaid managed care, along with other cuts that result in a 20% reduction in payment for dual eligibles, has put “the future health of our elderly, of our uninsured and Medicaid population … seriously at stake,” said Dr. Gonzalez, president of the Hidalgo-Starr County Medical Society, at the March 27 rally.

With cuts to physician pay, he said, doctors “have really reconsidered and have left the area.” He and others called for doctors and patients to press legislators to reverse the changes, which went into effect March 1.

Texas is one of many states where physicians are wrestling with the effects of — and fighting back against — the expansion of managed care into the poorest, oldest and often sickest population of patients. Bringing in managed care is designed to clamp down on costs and adds a private sector intermediary for medical decisions.

Dual eligibles were largely left out when states dramatically increased the use of managed care for Medicaid enrollees beginning in the 1990s. Medicaid managed care programs are approved through a waiver process by the Centers for Medicare & Medicaid Services, so expansion has been on a state-by-state basis and has built over time.

In 2010, about 39 million Medicaid beneficiaries were enrolled in managed care — about 71% of the total, according to the Kaiser Family Foundation. As of 2009, only about 12% of dual eligibles were enrolled in managed care. In the past, federal and state officials have expressed concern about putting a vulnerable population of elderly poor into managed care.

Dual eligibles are 15% of the Medicaid population but account for 39% of spending.

However, state budgets have come under severe strain, and with the passage of the Patient Protection and Affordable Care Act in March 2010, the federal government encouraged states to experiment with ways to control spending on dual eligibles. The health system reform law established the Medicare-Medicaid Coordination Office at CMS, tasked with improving the quality of care and controlling spending.

Together with the CMS Center for Medicare and Medicaid Innovation, the Medicare-Medicaid Coordination Office gave states incentives to try new ways to improve the clinical quality of dual eligibles’ care and control the cost of that care. At stake is $300 billion in annual spending across Medicare and Medicaid for a group that makes up 15% of the Medicaid population but accounts for 39% of the program’s spending, and 21% of Medicare’s enrollment but 36% of Medicare spending.

Growing trend

Twenty-four states and the District of Columbia have moved at least some dual eligibles into managed care, according to the Kaiser Family Foundation. Many of those states are considering expanding the dual-eligible population in managed care, while others are taking the first steps toward moving those patients there. In April 2011, CMS gave 15 states $1 million grants to assist in designing managed care initiatives that would reduce costs and improve the clinical quality of care for dual eligibles. Twelve of those states already had some dual eligibles in Medicaid managed care, but three — Connecticut, Oklahoma and Vermont — did not.

By moving dual eligibles to managed care, states hope to save money on what Medicaid covers, which mostly are the out-of-pocket expenses associated with Medicare deductibles. Texas, for example, hopes to save $475 million over two years with the changes it has made to dual-eligible coverage. Texas requires anyone on Medicaid older than 21 to be in the state’s managed care program, Star-Plus. Dual eligibles moved into the program in full as of March 1. That was only two months after the state cut coverage to dual eligibles.

71% of Medicaid beneficiaries were enrolled in managed care in 2010.

“The people who are affected are our most fragile, our elderly, our poor, the ones who are unable to fend for themselves,” C. Bruce Malone, MD, an orthopedic surgeon from Austin, Texas, president of the Texas Medical Assn., said at the March 27 rally.

The start of a new year of Medicare deductibles, the state’s payment rate cuts and a technical glitch in claims processing meant that some Texas physicians have been paid nothing for caring for some of their neediest patients since the beginning of 2012.

As many as half of the patients who come to the family practice of Javier Saenz, MD, in La Joya, Texas, are dual eligibles. In March, he had to take out a line of credit at the bank, because he had run through his savings trying to keep his practice open. It was the first time since opening his practice 26 years ago he had been forced to borrow money for operations.

The state’s effort to shift his patients into managed care plans has reduced his time with patients and added to his administrative burden, he said. He has to call managed care companies for approval for common diagnostic tests.

“They’re taking time away from us,” Dr. Saenz said. “We’re asking [the health plan] to approve certain services, and we’re talking to somebody 300 miles away.”

The Texas Health and Human Services Commission is looking for ways it can mitigate the pay cuts’ impact on physicians whose care is most vital, department spokeswoman Stephanie Goodman said.

24 states and the District of Columbia have at least some dual eligibles in managed care.

The momentum of managed care for dual eligibles is growing, despite the backlash. Not only do states feel they can save money by doing that, but health plans also believe they can make money in that business by helping states save on their Medicaid budgets. A 2011 research paper funded by the insurance trade group America’s Health Insurance Plans found that under the best-case scenario, managed care for dual eligibles could save $150 billion during the next 10 years.

In California, Gov. Jerry Brown is pushing for more managed care enrollment for its 1.5 million dual-eligible Medi-Cal enrollees, and California is one of 15 states with a CMS-approved managed care demonstration project in the planning stages, expected to launch in January 2013.

Ted Mazer, MD, an otolaryngologist from San Diego who serves on a Medi-Cal advisory committee, believes there are better approaches to saving money on Medicaid.

“I think there’s a population of [dual eligibles] here whose care is badly managed,” said Dr. Mazer, vice speaker of the California Medical Assn.’s House of Delegates. “But they are no different than any Medicaid patient who is not well-managed. If you want to identify all of those folks and put them into case management, that would be much more sensible.”

Alzeheimers costs high

Posted: Thu, Mar. 8, 2012, 2:56 PM

Alzheimer’s, Dementia Care to Cost U.S. $200 Billion This Year

THURSDAY, March 8 (HealthDay News) — Caring for people with Alzheimer’s disease and other types of dementia will cost the United States about $200 billion this year, a total that includes $140 billion paid by Medicare and Medicaid, new statistics released Thursday show.

Medicaid payments are 19 times higher for seniors with Alzheimer’s and other dementias and Medicare payments for the conditions are nearly three times higher, compared to payments for other patients, according to the “2012 Alzheimer’s Disease Facts and Figures” report from the Alzheimer’s Association.

Nearly 30 percent of people with Alzheimer’s and other dementias are covered by both Medicare and Medicaid, compared to 11 percent of people without the conditions. This means that Medicare and Medicaid costs associated with Alzheimer’s and other dementias will continue to rise as baby boomers age, the report said.

“Alzheimer’s is already a crisis, and it’s growing worse with every year,” Harry Johns, president and CEO of the Alzheimer’s Association, said in an association news release.

“While lives affected and care costs soar, the cost of doing nothing is far greater than acting now. Alzheimer’s is a tremendous cost-driver for families and for Medicare and Medicaid. This crisis simply cannot be allowed to reach its maximum scale because it will overwhelm an already overburdened system,” Johns added.

Most people with Alzheimer’s and other dementias have at least one other serious chronic health problem, and Alzheimer’s acts as a “cost multiplier” on these other diseases, according to the report.

For example, the statistics showed a senior with diabetes and Alzheimer’s costs Medicare 81 percent more than a senior with diabetes alone. And a senior with cancer and Alzheimer’s costs Medicare 53 percent more than a senior with cancer alone.

Mental impairment in patients with Alzheimer’s and other dementias complicates the management of care, resulting in more and longer hospital stays, the authors noted in the news release.

“This disease must be addressed on parallel tracks: supporting research to find treatments that cure, delay or prevent the disease, and offering assistance and support to the more than 5 million Americans now living with Alzheimer’s and their more than 15 million caregivers,” Johns said.

“This is what the National Alzheimer’s Plan is all about. Caring for people with Alzheimer’s and other dementias costs America $200 billion in just one year. By committing just 1 percent of that cost, $2 billion, to research, it could begin to put the nation on a path to effective treatments and, ultimately, a cure,” he noted.

The report also said that 800,000 people with Alzheimer’s — one out of seven — live alone, and that up to half of them do not have an identifiable caregiver. That puts them at increased risk for such health problems as missed or delayed diagnosis, malnutrition and untreated medical conditions. They’re also at increased risk for wandering away from home unattended and for accidental death.

Alzheimer’s patients who live alone tend to be older, female and have lower levels of cognitive (memory and thinking) impairment, the report noted. However, they still face major challenges in performing daily tasks such as managing money and medications, shopping and preparing meals.

“Advance planning is important for everyone, particularly for individuals who have Alzheimer’s or other dementias; but for the population that has Alzheimer’s and lives alone, future planning is absolutely critical,” Beth Kallmyer, vice president of constituent services for the Alzheimer’s Association, said in the news release.

According to the association, an estimated 5.4 million people have Alzheimer’s disease, and 15.2 million of their friends and family members provide 17.4 billion hours of unpaid care.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about Alzheimer’s disease.

— Robert Preidt

SOURCE: Alzheimer’s Association, news release, March 8, 2012

Copyright © 2012 HealthDay. All rights reserved.