Improving Treatment of Behavioral Health in Duals Programs Will Take Longer than Expected, Plan Executives Tell AIS

Share Article

Medicare-Medicaid dual-eligible programs will continue to improve integrated care, but accomplishing other goals, specifically related to behavioral health, will take longer than many have expected, according to reporting in the May 7 issue of Atlantic Information Services’ Medicare Advantage News.

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 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

About Medicare Advantage News
Medicare Advantage News is the health care industry’s #1 source of timely news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in this hotly contested area of health insurance. Published biweekly since 1994 (when it was Medicare+Choice), the newsletter exists to help plans boost revenues, increase enrollees, cut costs and improve outcomes in Medicare Advantage and Medicaid managed care. Visit for more information.

About AIS    
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Jill Brown, Executive Editor
Atlantic Information Services
+1 (202) 775-9008 Ext: 3058
Email >
since: 01/2011
Follow >
since: 01/2011
Like >
Atlantic Information Services, Inc.

Visit website