Washington, DC (PRWEB) May 13, 2015
Now that almost all of the Centers for Medicare & Medicaid Services (CMS)-backed programs for Medicare-Medicaid dual-eligibles are active, it’s clear that despite early improvements in integrated care, achieving some of the more ambitious goals will take longer than expected, health plan executives say. This was the consensus view of the 11 speakers at a recent Atlantic Information Services virtual conference on dual-eligible programs, covered in the May 7 issue of the publisher’s Medicare Advantage News.
One of the major problems cited by the speakers was integrating behavioral health (BH), causing Brian Wheelan, executive vice president and chief strategy officer at behavioral health managed care specialist Beacon Health Options, to call it an “unrealistic” goal. Wheelan and Tom Standring, vice president, Medicare, at Molina Healthcare, Inc., cited regulations surrounding protected health information (PHI) as a setback. More pressingly, according to Wheelan, the necessary infrastructure needed to treat mentally ill patients doesn’t exist. “There still is an immediate shortage of sub-acute services and crisis-stabilization beds” for duals with BH issues, he said, which will take time to set up.
There are also a lot of dual eligibles in need of behavioral health services. Lois Simon, president of Commonwealth Care Alliance (CCA) in Massachusetts, said that of the more than 10,000 enrollees CCA has attracted in the Massachusetts duals demo, 70% have a BH diagnosis. And many of them who are classified needing a relatively low degree of care turn out to be more seriously ill, she noted. This contributes to another issue: about 25% of medical spending in the Massachusetts duals demo is used for pharmacy, which is much higher than the senior population CCA serves outside the demo.
Visit http://aishealth.com/archive/nman050715-02 to read the article in its entirety, including analysis of other reasons behind the setbacks — such as high start-up costs, delays in governmental guidance, issues integrating long-term care and more — as well as the areas in which the demo is working well. For more information on the April 16 virtual conference, and to purchase a recording, visit http://aishealth.com/marketplace/c5va02c.
About Medicare Advantage News
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