Centralized data helps coordinate duals

WASHINGTON-Centralizing data and performing routine health risk assessments will help caregivers effectively treat the vulnerable dual eligibles and reduce their disproportionately high costs, a healthcare alliance says.

In a policy paper released last month, the Care Continuum Alliance (CCA) identifies such strategies among six core components it recommends for the 9 million Americans who qualify for both Medicare and Medicaid coverage.

"It is a constant struggle because of the population being served," says Tracey Moorhead, president and CEO of the alliance. "This population tends to move in and out of Medicaid eligibility. They tend to move physically and be difficult to reach."

"Any interaction with the healthcare community should begin with a health risk assessment," Moorhead says. "It is truly the only way to fully understand the scope of the beneficiary's needs and allows the providers serving the patient to identify their location on the continuum of care."

The policy paper advocates the use of accredited assessments tailored to specific groups of patients, the creation of Medicare and Medicaid incentives to encourage administering them, and a requirement that patients be assessed upon enrollment.

The assessment can identity opportunities for more effective treatment and lower per-patient costs-a key concern, since 21% of Medicare enrollees account for 36% of spending, and 15% of Medicaid patients account for 39% of spending. Better planning can postpone or avoid long-term care by aligning patients with community-based services before their needs are critical. Also, CCA advocates the use of incentives for patients and providers.