« The Dual Agenda: October 1, 2014 Issue

Noteworthy News

MMCO Study Documents Physical and Mental Health Conditions Among Duals

The Medicare-Medicaid Coordination Office (MMCO) released a new report, “Physical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service (FFS) Medicare-Medicaid Enrollees." Using data from 2008, the study provides an illustrative view of diagnosed physical and mental health condition prevalence and comorbidity rates among FFS dually enrolled beneficiaries, overall, as well as by different enrollee subpopulations and by state. Among the study’s key findings:

• Sixty percent had diagnoses across at least three different physical and mental health condition groups
• A full quarter of patients had diagnoses across five conditions
• Forty-one percent had at least one mental health condition, excluding substance use disorders
• Three-quarters had a heart-related condition.

Institute of Medicine Releases Major Report on End-of-Life Care  

On September 17, the Institute of Medicine (IOM) released a 500-page report entitled “Dying in America.” This is the first major report by the IOM on issues surrounding end-of-life care since 1998. The new report finds that “improving the quality and availability of medical and social services for patients and their families could not only enhance quality of life through the end of life, but may also contribute to a more sustainable care system.” The report brief states there is a “pressing need” to improve end-of-life care, and lists crucial issues of relevance to dual eligible populations, including: barriers to care that disadvantage certain groups; a fragmented delivery system; the need for more provider training in palliative care; and “a mismatch between the services patients and families need and the services they can obtain.” The report highlights concrete areas where there are opportunities for improvement to move towards a culture that embraces the delivery of quality care that honors individual preferences near the end of life.

Battling the Health System to Allow a Father to Die with Dignity

In the wake of the Institute of Medicine’s new report, “Dying in America” (above), a September 25 article in the New York Times puts a very human and personal face on many of the issues raised in the report. It is a “must read” for those working to transform the health care system in the U.S. generally – and to bring better care to dually eligible individuals and others toward the end of their lives, specifically. The article points out older patients with complex chronic conditions are increasingly likely to be shuttled among hospitals, nursing homes and hospices in pursuit of covered Medicare and Medicaid care, as they progress toward the end of their lives. Ultimately, most die in an institution, rather than at home, even when that is clearly against their stated preference. Through telling the story of one adult daughter’s desperate efforts to fulfill her 91-year-old father’s wish to be cared for in his own home at the end of his life, the story poignantly illustrates what advocates are up against as they seek to change the U.S. health care system. The story of Joseph Andrey and his daughter, Maureen, touches on many of the structural issues that drive up health care costs toward the end of life, while often frustrating the wishes and ignoring the preferences of individuals and their families. 

New Report on Camden, NJ Groundbreaking “Hotspotting” Program

The Center for Health Care Strategies reports on the so-called “hotspotting” program that has been pioneered in Camden, New Jersey. A coalition of health care providers in Camden has come together to use a data-driven process to improve health care and reduce costs. “Hotspotting” identifies extreme patterns of health care use and pairs that with targeted interventions and follow up to provide patients with better care. The project began as an attempt to understand how violent crime was impacting city residents, and that data revealed that about ten percent of patients accounted for seventy-five percent of hospital spending. Today, the Camden coalition of healthcare providers uses this data to implement community-based solutions that will provide better care to these patients while simultaneously reducing costs. A 2013 Community Catalyst Health Policy Hub blog reported on Dr. Jeffrey Brenner, who launched the Camden project, and the relevance of these innovations to the dual eligible demonstration projects.