The Holy Grail of reducing expenditures associated with providing medical and long term care services (LTC) to this complex population is propelling states to look to managed care organizations (MCOs) for answers. The reasoning is something like: since MCOs are capable of managing the expenditures of younger Medicaid beneficiaries, surely they will be able to reduce them for older adults in ways that will not jeopardize quality of life. In these days of relying on private enterprise to achieve a public good, this strategy is lauded by those who have faith in the abilities of free-enterprise, while elder care providers and advocates for older adults warily look on, as MCOs rev up for enrollment in seven states over the next six months.
A recently published research paper (here) offers a fresh perspective on how opaque the causes are of the disparate impact that duals have on Medicare and Medicaid expenditures. The chart (above) contained in the paper, captures the complexity of the relationship between setting (i.e. residing in the community or in a skilled nursing facility) and beneficiary status (dual or non-dual-Medicaid only). As the authors note, increased frailty associated with needing LTC (columns A-D) results in higher medical and overall expenditures and increased medical costs than those who do not required LTC (columns E-G).
The researchers ponder why medical care expenditures for institutional duals (column C) are significantly less than those in the community (column A), but not as low as those non-duals who live in the community (column B). Seemingly, skilled nursing facilities (reimbursed through Medicaid) are somehow reducing medical care expenditures. But, how? Presumably more medical care is being delivered in the skilled facility than in the hospital, but more research is needed.
Clearly, MCO’s will need to rely on those providers who currently meet the challenge of providing quality, cost-effective LTC to duals living in the community and in the skilled center. There are innovative providers of community-based and skilled nursing services and skilled nursing services that are willing to partner with MCO's to meet this challenge. What do you think?
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