In an open letter sent today, Arnold Ventures urged the newly confirmed Administrator for the Centers for Medicare and Medicaid Services (CMS) to begin work on opportunities to improve care for people with complex needs who were among the most impacted by the COVID-19 pandemic.
Even before the pandemic, the 12 million people who are dually eligible for Medicare and Medicaid struggled to navigate two distinct and fragmented care systems, a disconnect that left many experiencing worse health outcomes than their counterparts enrolled in Medicare alone. The pandemic underscored that fragility — dual-eligible individuals have been three times as likely to be hospitalized with COVID-19 than the average Medicare beneficiary — and amplified the urgency to improve the system delivering their care.
In her new role overseeing CMS, Chiquita Brooks-LaSure has an opportunity to guide the agency toward policies and procedures that strengthen care delivery models to better address the needs of dual-eligible individuals and shift long-term care services more toward home- and community-based models, which allow older adults and those with disabilities to continue living at home.
To address some of the shortfalls in the current fragmented care model, we recommend integrating Medicare and Medicaid’s financing, benefits and experience for enrollees, creating a unified system that allows people to thrive in their own homes and communities.
Over the last decade, the potential of integrated care has become more mainstream, but more work remains to be done. Today, only one in 10 dual-eligible individuals are enrolled in fully integrated models.
States, forced to navigate a confusing landscape and patchwork of integrated coverage options, have not implemented integrated models on a wide scale. Even those that do offer such models see low beneficiary enrollment
The situation remains confusing for beneficiaries. Many individuals don’t understand the integrated models available to them, aren’t encouraged to choose them and may be discouraged by their providers from doing so.
While Congressional approval will likely be needed to fully integrate the two programs, CMS has the power under its authority to better streamline integration and incentivize enrollment in integrated coverage options.
Our letter outlines six principles for consideration to address some of the key challenges afflicting the dual-eligible population, and identifies proposed solutions for improving care.