New program to develop strategies for Medicaid/Medicare dual eligibility

first_imgAs the nation debates health reform options, Governor Jim Douglas today announced that Vermont was chosen to participate in Transforming Care for Dual Eligibles, a national initiative that will test innovative models for people who are dually eligible for Medicare and Medicaid . Vermont will join six states in developing and implementing strategies to improve care and control costs for dual eligibles, a high-need population with individual health care costs nearly five times those of other Medicare beneficiaries. The program is designed by the Center for Health Care Strategies (CHCS) and supported by The Commonwealth Fund. I m so proud that Vermont is once again leading the nation in its health care reform efforts, said Governor Jim Douglas. Vermont is first in the nation to have a Choices for Care 1115 Long Term Care Waiver program, which equalizes entitlement to nursing home and home/community based services for long term care Medicaid eligible Vermonters. In addition, Vermont developed the Global Commitment 1115 Waiver, a first in the nation Medicaid Waiver wherein the State is the managed care organization. This grant will help us continue to make progress toward lowering the growth in health care costs for Vermonters eligible for both Medicare and Medicaid.Under the new grant, Vermont will work with CHCS and the Centers for Medicare and Medicaid Services (CMS) on the authority and process to create a pilot where Vermont would be a Special Needs Plan (SNP). As a SNP, Vermont would work with local providers to serve dually eligible beneficiaries across both of Vermont s waivers. As we look toward reforming our health care system, there are significant opportunities to improve the quality and cost-effectiveness of care for people who are eligible for both Medicaid and Medicare coverage, whose needs are often overlooked, said Commonwealth Fund President Karen Davis. The work of these seven states in designing patient-centered delivery models, if successful, could help pave the way for other states seeking to improve care for these vulnerable beneficiaries.Nationally, the more than eight million adults who are dually eligible represent approximately 18% of the Medicaid population, but account for 46% of the program s costs due to their complex array of medical, behavioral, and long-term care needs. A majority of dual eligibles are in fragmented fee-for-service systems, with little to no care coordination. Integrating the financing, delivery, and administration of services across Medicaid and Medicare could significantly reduce unnecessary hospitalizations and decrease the use of institutional care over time. This is exactly that type of program integration we need in order to provide better care for our citizens, Douglas continued. Through my work as co-chair of the National Governors Association State Alliance for e-Health, we are pursuing strategies for increased long-term care coordination with electronic medical records to better serve those with chronic conditions. I will continue to lead both nationally and here at home so that we can make important reforms and provide better care to Vermonters.Vermont is joining Colorado, Maryland, Massachusetts, Michigan, Pennsylvania, and Texas, in seeking to eliminate the barriers to integrating Medicaid- and Medicare-covered services. Through the 18-month program, participating states will receive in-depth technical assistance addressing program design, care models, financing mechanisms, contracting strategies, and working with CMS. With growing momentum, including Congressional interest, for integrating care, it is an ideal time to develop and test new state approaches to improve the quality of care for duals, said Melanie Bella, Senior Vice President at CHCS. We applaud Vermont for its commitment to establish practical and replicable solutions for integrating Medicaid and Medicare and improve care for dual eligibles in the state.The Transforming Care initiative continues the work begun by CMS and five states under CHCS’ earlier Integrated Care Program to address operational hurdles to integrating care by contracting with SNPs. The new program s goal is to develop a range of integrated delivery models for dual eligibles that can be implemented by other states across the country. Lessons from participating states will be disseminated to Medicaid stakeholders throughout the course of the initiative.The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system. For more information, visit www.commonwealthfund.org(link is external).The Center for Health Care Strategies (CHCS) is a nonprofit policy resource center dedicated to improving health care quality for low-income children and adults, people with chronic illnesses and disabilities, frail elders, and racially and ethnically diverse populations experiencing disparities in care. CHCS works with state and federal agencies, health plans, and providers to develop innovative programs that better serve Medicaid beneficiaries. For more information, visit www.chcs.org(link is external).Source: Governor’s officeVermont Resources:For details about the Choices fro Care Waiver, please refer to http://www.ddas.vermont.gov/ddas-programs/programs-cfc/programs-cfc-defa(link is external)…).For details about he Global commitment waiver, please refer to: http://ovha.vermont.gov/administration/2008-global-commitment-to-health-(link is external)…)last_img read more