Penn LDI/Health Affairs Conference Explores Dual Eligibles Care Integration

In an event that drew 10 dozen state and federal officials, university researchers, insurance executives, and health care organization managers to the University of Pennsylvania, the Leonard Davis Institute of Health Economics (LDI) and the Health Affairs journal held a July 22 conference focused on the integration of Medicare and Medicaid services for dual eligibles. The decades old issue remains one of health care’s most intractable problems.

In 1965, when Congress created the world’s largest public health insurance program and bifurcated it into two different systems—Medicaid and Medicare—legislative policymakers did not think much about how these two systems would ultimately overlap in the future.

Medicaid is essentially aimed at people of all ages who can’t afford to pay for medical care. Medicare is aimed at providing care to people over 65. Given its focus on low-income and marginalized populations, Medicaid has large groups of patients with severe disabilities and multiple chronic diseases. As these patients grow older and reach 65, they also go on Medicare, thus becoming dually eligible for the benefits of both systems. But the exact way in which that care should be delivered, funded, and managed between the two programs has never been comprehensively defined.

Centerless Duals System

Medicare and Medicaid have different rules, regulations, requirements, restrictions, and procedures. These incompatibilities are further compounded by the fact that there are 50 different state Medicaid programs which are themselves often incompatible with each other. Inevitably, dual eligibles are often caught in a tangle of administrative inconsistencies and contradictions in a centerless duals system that prevents the delivery of needed care in ways that often result in catastrophic outcomes. Dual eligibles routinely face higher rates of hospitalization, emergency room visits, and other adverse health events due to the inefficiencies and gaps in a system that was essentially formed by accident rather than by evidence-informed and clearly thought-out policies and operational plans.

The Penn conference was the latest to assemble a corps of top experts to better understand how policymakers might forge a coherent path toward a model of fully integrated care for this highly vulnerable population.

As he opened the “Forging a Path Toward Integrated Care for Dually Eligible Individuals” conference, Alan Weil, JD, MPP, Editor-in-Chief of the Health Affairs journal noted that his nearly 30 years of involvement with dual eligibles has given him a deep historical perspective on the problems that continue to hobble the program.

“Tremendous Risks”

“Integration is a challenge,” Weil said. “We have two programs with different rules, different governance, different financing, different cultures. None of that has changed. There is still the open question of who is the integrator?…