The Department of Health and Human Services (HHS) recently launched initiatives in the states to help save money and better coordinate care for the 9 million Americans enrolled in both Medicare and Medicaid (called dual eligibles).

The Alignment Initiative, which includes better access to Medicare data and improved coordination of care between Medicare and Medicaid, will be led by the new Federal Coordinated Health Care Office (the Medicare-Medicaid Coordination Office). It was created by the Affordable Care Act to help make the two programs work together more effectively.

““Medicare and Medicaid spends $300 billion each year to care for people enrolled in both programs,” said Centers for Medicare and Medicaid Services (CMS) Administrator Donald M. Berwick. "Better coordinated care for this vulnerable population could yield savings and improve care and coverage in Medicaid.”

Currently, 60 percent of dual eligibles have multiple chronic conditions and 43 percent have at least one mental or cognitive impairment. While only 15 percent of Medicaid enrollees are also Medicare beneficiaries, dual eligibles represented 39 percent of Medicaid spending in 2007. Medicaid spent about $120 billion on this group – about twice as much as Medicaid spent on the 29 million children it covered. The Medicaid spending per dual eligible was $15,459 in 2007, more than six times higher than the comparable cost of a non-disabled adult Medicaid-only enrollee ($2,541).

The Medicare-Medicaid Coordination Office is seeking input and ideas about how to align in six areas: care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment, and appeals. Better alignment in these areas can reduce costs by improving health outcomes and making care coordination more efficient.

HHS also announced a new process that provides faster state access to Medicare data to support care coordination. Access to Medicare data is an essential tool for states seeking to coordinate care, improve quality, and control costs for their highest cost beneficiaries.

For example, a state that wants to expand its long term care and behavioral health care management program to serve low income seniors and people with disabilities needs data on their Medicare-covered hospital, physician, and prescription drug use. With Medicare data, states can identify high risk and high cost individuals, determine their primary health risks, and provide comprehensive individual client profiles to its care management contractor to tailor interventions.

Those interested in making public comments on the Alignment Initiative may submit them until July 11, 2011.

Instant Insights /

HHS launches Medicaid, Medicare cost controlling initiatives

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