Voices for Better Health
There are over 10 million people in the country who have both Medicare and Medicaid. Sometimes referred to as “dual eligibles,” these individuals have trouble navigating through these two complicated health care systems, often feeling lost in a maze of multiple doctors, medications and programs. Far more than the general population, they bounce in and out of emergency rooms, hospitals and nursing homes, often experiencing poor care and unnecessary complications. The price tag for this ineffective care is massive: more than $300 billion annually.
Options for Better Health
The Affordable Care Act has launched initiatives to allow states to develop innovative demonstration projects to provide better coordinated, comprehensive, high quality care to dual eligibles. Community Catalyst has a long history of working to improve systems of care for Medicare-Medicaid enrollees. Building on that experience, the Voices for Better Health program is partnering with state and local advocates in Michigan, New York, Ohio and Rhode Island to shape the design and implementation of these initiatives so they best serve the needs of this unique population by:
- Allowing patients to choose plans or providers that can best serve their needs and improve their quality of life
- Emphasizing community and home-based services over institutional care
- Creating payment rates that ensure the needs of those with the most complex conditions are met
- Respecting the cultural and linguistic needs of patients and caregivers
If designed well, these initiatives can help reduce preventable hospital and nursing home admissions and improve overall health and quality of life for dually eligible individuals.
Advancing State and Federal Policy on Care for Dual Eligibles
State and federal policymakers, particularly concerned about the high costs of care for dual eligibles, hope these initiatives will produce significant cost savings. While this is an important goal, there is the risk that the drive to save money will overshadow the goal of achieving better quality care. Through Voices for Better Health, Community Catalyst works to educate policymakers and other key stakeholders about what’s needed to improve outcomes and save money while protecting the dually eligible population. It also equips consumer advocates with the resources and expertise necessary to establish a seat at the table for themselves and for Medicare-Medicaid enrollees and their caregivers as this important policy debate takes shape.
Moving Plans and Provider Groups Toward Meaningful Consumer Engagement
One of the keys to creating a successful health care delivery system for dual eligibles is developing meaningful ways of soliciting the input of those being served. Voices for Better Health is working with delivery systems – health plans and provider groups – to develop these approaches, from member meetings to consumer advisory councils to including consumers on governing boards. At the same time, the Voices for Better Health state partners are working at the grassroots level to help consumers understand the vital importance of their input and prepare them to take part in increasing levels of engagement.
Infusing Geriatric Best Practices in Dual Demonstrations
Over half of the dually eligible population are older adults, many of whom are frail or have multiple chronic conditions. Building evidence-based delivery systems that can best serve this population requires a new level of collaboration between consumer advocates and geriatrics practitioners. Voices for Better Health is drawing on the expertise of leaders in the geriatrics community, including front-line physicians, nurses, social workers and other providers and researchers. This partnership seeks to incorporate best practices in geriatrics care, which have been shown to improve efficiency, quality and outcomes, in the dual eligible demonstration projects.