Existing empirical evidence suggests policymakers shouldn’t count on the large Medicare savings some have projected will stem from either a managed care or coordinated care solution, according to a Kaiser Family Foundation Issue Brief.
The approximately seven million Americans who are dually eligible for full Medicare and Medicaid benefits are costing both systems a significant amount of money, but programs meant to achieve cost savings while providing better care are barely saving any money, says Kaiser.
While several pilot programs meant to improve care for the dual eligible population have been successful in reducing hospitalizations, only a couple programs have actually achieved cost savings to Medicare and Medicaid.
The report notes that none of the FFS-based care management programs that showed strong evidence of cost-savings served populations who required substantial amounts of long-term supports and services. That makes it hard to say whether these approaches would work for the 36% of dual eligibles who require these services, Kaiser says, and those care coordination programs might not be as effective at reducing hospitalizations among that more complex and expensive “subgroup” of dual eligibles.
Written by Alyssa Gerace