6 Keys to Successful Care Management of Dual Eligibles
Applying a blanket care management approach to all dual eligible populations "is a waste of time and effort," notes Dr. Timothy Schwab, chief medical officer, SCAN Health Plan.
Instead, care coordination for individuals covered by both Medicare and Medicaid should start with a strong risk stratification program, taking into account the age bands as well as the functional, medical and social status of the population.
Dual eligibles are a diverse group with different long-term care needs; nationwide, about 40 percent of duals meet 'nursing home-certifiable' status, he explains. Additionally, about 35 percent of duals are under 65 years of age, Dr. Schwab said during a recent webinar on Care Coordination for Dual Eligibles: a Results-Oriented Approach. Nearly two-thirds of these duals have only a single chronic condition and no functional impairments.
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The federal government has only recently begun to recognize some of duals' unique needs, he explained. The ACA created both the Office of the Duals and the CMS Innovation Center to pilot new care delivery models.
Operating the only fully integrated dual eligible special needs plan (FIDE SNP) in California, SCAN has a history of successful care management of dual eligibles, who constitute about 9 million individuals in the United States.
The risk stratification should be followed by a very strong multifactorial assessment that goes beyond a traditional medical assessment of a population, followed by the development of individualized care plan, a process that requires buy-in from both the member and the significant caregiver, if one exists, Dr. Schwab states. Goals formulated by an interdisciplinary care team or other stakeholder, a fourth aspect of duals care management, should be meaningful to the member but also realistic to the care manager, Dr. Schwab emphasizes.
There should also be built into care management a reporting feature so that progress toward members' goals can be tracked and adjusted if necessary.
Finally, inherent in the care management approach should be close attention to the member's language, cultural norms, and health literacy, as well as their home environment, which impacts everything from a dual's nutrition to transportation to compliance with care and medical goals.
You can "attend" this program right in your office and enjoy significant savings no travel time or hassle; no hotel expenses. Its so convenient! Invite your staff members to watch the conference. We will send you a DVD or CD-ROM of the conference proceedings or a link to our web site with a username and password. You can log in and view the program right from your computer any time of the day or night, whenever convenient for you and your colleagues and benefit from the archived recording of the conference, including the Q&A period.
You'll get to listen to the question and answer session to hear sources for care management protocols addressing the utilization of long-term care services and support; how to measure the effectiveness of the various case management approaches; data on the cost on a per-patient-per-month basis for a care coordination model; successful care transition management of duals and special considerations at hospital discharge; the qualifications of the care coordinators and care manager and how they can interact with the medical home or PCP; addressing spending cuts in transportation; the role of perspective coding assessments in a risk stratification methodology; and effective strategies for working with dual eligibles who have multiple physical health and behavioral health, chronic and acute conditions.
To register for the on-demand re-broadcast of Care Coordination for Dual Eligibles: a Results-Oriented Approach or order the training DVD or CD-ROM, please visit:
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