elderly, generations, father, child, baby boomers,

Coordinated care improves health for the poorest, sickest patients

Jul 17 2014

A health plan in Arizona has found that a team approach to caring for patients can reduce hospital stays.  Four other Aetna plans are now working with partners in other states on their dual eligible pilot programs to replicate these results. Mercy Care Plan, a not-for-profit health care plan in Arizona administered by Aetna, uses a team of social workers, pharmacists and other health professionals to provide coordinated care. This model includes a strong focus on prevention, disease education and case management.

Mercy Care covers members known as “dual eligibles.” This means they qualify for both Medicaid and Medicare. They have to navigate the complexities of both systems and often need to fill out different forms for each program to receive medications. Mercy Care cuts some of this red tape by appointing a case worker who helps bridge the gap between the two programs. This helps patients get the care they need.

Research shows this approach has been effective at improving patient health and lowering the cost of care. A 2012 study by the consulting firm Avalere found that Mercy Care’s dual eligible patients spent roughly 40 percent fewer days in the hospital than the national average for a similar population in fee-for-service Medicare. Mercy Care’s dual eligible patients also had shorter hospital stays, fewer readmissions and fewer emergency room visits.

This study has lessons for the more than 10 million dual eligible patients treated nationally. According to the Centers for Medicare and Medicaid Services, more than $300 billion a year is spent caring for this population. Included in that figure is waste generated by a lack of coordination or oversight, as ProPublica reported in November 2013.

“I appreciate somebody on the other side looking out for my well-being and not just looking at me as a number on a paper.”

Policymakers are eager to find ways to help dual eligibles at the lowest possible cost. The Affordable Care Act offers a three-year testing opportunity for states to develop a coordinated care delivery system for this population. Although some states have dropped out or delayed the Medicare-Medicaid Financial Alignment Initiative, some states are starting the program. Many policymakers and states view this as a good opportunity to test a new approach for coordinating care and improving outcomes for this high-cost, vulnerable population.

People receiving the team approach like it. A National Public Radio story from February 2013 described Mercy Care’s program through the eyes of a dual eligible named Joseph Ford. According to Ford, his health plan case manager is a bit like a guardian angel. “Dave is cool,” Joseph says. “He’s in my cellphone. I appreciate somebody on the other side looking out for my well-being and not just looking at me as a number on a paper.”