Managing Care Transitions for the Dually Eligible Population: Crafting a New Care Model for Medicare/Medicaid Enrollees

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Medicare beneficiaries who are also eligible for Medicaid -- referred to as "dual-eligibles" -- are a vulnerable population due to their low incomes and increased likelihood of chronic illness, hospitalization and long-term care. According to Mathematica Policy Research Inc., about 11 percent of older Americans covered by Medicare fall into the category of dual-eligibles. As this population transitions from one healthcare setting to another, they frequently encounter gaps in care that negatively impact their health, unnecessarily prolong hospital stays and specialty care, and unduly increase the burden on caregivers and family. Closing care transition gaps for the chronically ill Medicare enrollee who is also a Medicaid beneficiary will be the focus of "Managing Transitions to Care for the Dually Eligible Medicare and Medicaid Patient," a live interactive audio conference on February 14, 2007 at 1:30 p.m. Eastern time sponsored by the Healthcare Intelligence Network (HIN).

Medicare beneficiaries who are also eligible for Medicaid -- referred to as "dual-eligibles" -- are a vulnerable population due to their low incomes and increased likelihood of chronic illness, hospitalization and long-term care. According to Mathematica Policy Research Inc., about 11 percent of older Americans covered by Medicare fall into the category of dual-eligibles.

As this population transitions from one healthcare setting to another, they frequently encounter gaps in care that negatively impact their health, unnecessarily prolong hospital stays and specialty care, and unduly increase the burden on caregivers and family. These care gaps are most likely to occur when dual-eligibles transition from primary to specialty care, from the emergency department to the surgical floor, from hospital to home or from in-patient to long-term care.

Closing care transition gaps for the chronically ill Medicare enrollee who is also a Medicaid beneficiary will be the focus of "Managing Transitions to Care for the Dually Eligible Medicare and Medicaid Patient," a live interactive audio conference on February 14, 2007 at 1:30 p.m. Eastern time sponsored by the Healthcare Intelligence Network (HIN). For more information, please visit http://www.hin.com/cgi-local/link/news/pl.cgi?dualeligiblespr.

During the 90-minute audio conference, a team versed in the needs of this population will describe comprehensive care management strategies aimed at reducing hospital admissions and re-admissions among the dually eligible Medicare and Medicaid population. According to Melanie Matthews, HIN executive vice president and chief operating officer, establishing polypharmacy programs, in-person and/or telephonic coaching efforts, "medical homes" to coordinate patient care, and comprehensive education efforts aimed at caregivers can help bridge care transition gaps.

This increasingly serious healthcare issue has attracted the attention of a number of healthcare organizations around the country. The National Transitions of Care Coalition, composed of 13 leading U.S. organizations and companies, was formed in late 2006 to address the barriers and gaps that occur when patients, especially older adults, leave one healthcare setting and move to another.

Scheduled to present during HIN's 90-minute audio conference on February 14, 2007 are Diane Flanders, director of coordinated care systems at MassHealth, which oversees the state's integrated Medicare-Medicaid managed care programs, including Senior Care Options and the Program of All-inclusive Care for the Elderly, and Sarah Keenan, clinical liaison with Medica. They will offer details on:

  •     Lowering re-admission rates by managing the post-hospital transition period;
  •     Managing the doctor-to-doctor transition;
  •     Developing effective targeting strategies that can be used to identify those patients who are at greatest risk for experiencing complicated care transitions;
  •     Creating a "medical home" that can aid in managing transitions;
  •     Understanding and maximizing the role of health coaches, patient navigators and case managers in care transitions;
  •     Developing polypharmacy programs to avoid adverse drug interactions; and
  •     Creating treatment plans and inpatient discharge instructions that patients truly understand.

To register and obtain additional details on the February 14, 2007 audio conference, please visit http://www.hin.com/cgi-local/link/news/pl.cgi?dualeligiblespr.

"According to the Agency for Healthcare Research and Quality (AHRQ), the elderly represent about 12 percent of the U.S. population each year but account for about 35 percent of hospital stays," notes Ms. Matthews. Her organization has sponsored a series of audio conferences on improving transitions in care across a range of populations, including a forthcoming program on managing care transitions for the frail elderly.

The audio conference will be held on February 14, 2007 at 1:30 p.m. Eastern time. The 90-minute live audio conference includes a 30-minute question-and-answer period for participants. A recorded version on CD-ROM with a printed transcript will be available in late February, and an "On-Demand" audio conference re-broadcast can be accessed beginning February 16, 2007.

CEOs, medical directors, disease management directors, managers and coordinators, health plan executives, care management nurses, state Medicaid directors, and business development and strategic planning directors will derive maximum benefit from this audio conference.

About the Healthcare Intelligence Network

HIN is the premier advisory service for executives seeking high-quality strategic information on the business of healthcare. For more information, contact the Healthcare Intelligence Network, PO Box 1442, Wall Township, NJ 07719-1442, (888) 446-3530, fax (732) 292-3073 or visit http://www.hin.com.

Contact:    Patricia Donovan

Phone:    (732) 528-4468

Fax:    (732) 292-3073

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PATRICIA DONOVAN
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