CMS’s Care Coordination Effort for Dual Eligibles Pushing Too Far, Too Fast

Healthcare policy groups have a message for the Center for Medicare & Medicaid Services (CMS) regarding its efforts to improve care coordination for the nation’s dual eligibles: slow down.

At least one person has an even stronger opinion regarding the future of the initiative, reports Politico, as Senator Jay Rockefeller (D.-W.Va.) has called for an immediate halt.

Is the push to change how “dual eligibles” get their health care going too far, too fast?


That’s a question that’s beginning to be heard from lots of quarters—including the Medicare Payment Advisory Commission, the American Medical Association, some analysts and now at least one key lawmaker.

Health care providers and policy analysts broadly agree that the current care environment for dual eligible beneficiaries needs to change—and fast. The approximately 9 million people on both Medicare and Medicaid tend to have multiple health problems, and their care is both highly fragmented and very expensive.

Critics of the CMS demonstration for dual eligibles say it’s a classic example of the right idea but the wrong execution.


“The pressure is just so intense to come up with savings, not just at the national level, but at the state level, too,” said Edward Howard, executive vice president for the Alliance for Health Reform. “And these folks really are vulnerable.”

In a letter released late last week, Rockefeller eviscerated the pilot program, saying its design is weighted toward savings rather than on improving care. Rockefeller created under the health law the Federal Coordinated Health Care Office—a new CMS office tasked with figuring out how to make the federal Medicare program and the state-federal Medicaid program do a better job for this population.

Nursing home trade group the American Health Care Association (AHCA) says that CMS’s untested model for the effort potentially threatens the frailest nursing home residents.

“Coordination of benefits and other efforts should focus on better health for these seniors with an outcome of savings to the taxpayer,” says Mark Parkinson, President and CEO of AHCA. “CMS’ capitated, risk-based approach for dual eligibles is extremely concerning because the main focus appears to be reducing financial resources to this population and not providing better care.”

CMS appears to have led states toward an unproven structure with risks of disrupting care delivery to more than 9 million Americans, Parkinson continues, rather than implementing a controlled, defined array of pilot demonstrations that make improved care for dual eligibles a priority, with benefits to taxpayers as a secondary goal. 

CMS said in a letter to Politico that it’s aware of critiques of the care coordination effort.

“Given the diversity and significant health care needs of dual eligibles, we recognize how critical it is to have beneficiary protections in place to achieve the highest-quality health care possible,” CMS spokesman Brian Cook said in the email to Politico. “We are taking the input from Congress, MedPAC and others very seriously moving forward.”

Read the full article at Politico.

Written by Alyssa Gerace 

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