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Home > Healthcare Trends
Population Health Management for Dual Eligibles: Blueprint for Care Coordination
Population Health Management for Dual Eligibles: Blueprint for Care Coordination
Population Health Management for Dual Eligibles: Blueprint for Care Coordination
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Across the country, CMS is providing funding and technical support for select states to develop person-centered approaches to care coordination of dual eligibles, connecting primary, acute, behavioral health and long-term supports and services for beneficiaries of both Medicare and Medicaid.

The goal is to create care delivery and payment coordination models for this vulnerable population that can be piloted and replicated in other states.

Meanwhile, SCAN Health Plan has a history of successful care management of dual eligibles, who constitute about 9 million individuals in the United States. The not-for-profit California-based health plan has developed a multi-pronged, member-specific approach to reaching dual eligibles that has earned kudos from the healthcare industry.

Population Health Management for Dual Eligibles: Blueprint for Care Coordination details SCAN's unique care management model for duals, which focuses on prevention and early intervention, particularly in the area of medication management.

In this 27-page report, Dr. Timothy Schwab, chief medical officer, SCAN Health Plan, shares the health plan's strategic approach to serving the dual eligible market. He provides details on the following:

  • The issues and solutions for serving the dual eligible market;
  • Current trends in the dual eligible marketplace;
  • Developing relationships with long term care services and support providers to manage care for dual eligibles;
  • Integrating acute and long term care coordination; and
  • Metrics to follow in the dual eligible market.

Care coordination of dual eligibles has been identified by PricewaterhouseCoopers LLP as one of the top 10 healthcare priorities for 2013.

Also contributing to this special report is Hank Osowski, managing director of Strategic Health Group, who describes opportunities presented by the dual eligibles market in a post-ACA era. Many healthcare organizations are under intense pressure at the state and federal levels to find Medicaid and Medicare savings.

Osowski and several other thought leaders contribute their expertise to the Q&A portion of this resource.

Table of Contents

  • A Results-Oriented Approach
    • Dual Eligibles Care
    • Defining the Duals
    • Factoring in Functional Impairment
    • Defining Program Goals, Metrics and Population
    • The Role of Care Management
    • Starting with Risk Stratification
    • Considering the Home Environment
    • Opportunities from Dual Eligibles
  • Business Opportunities Related to Dual Eligibles
    • Success Stories
    • Program Risks
  • Q&A: Ask the Experts
    • SCAN Interdisciplinary Care Team
    • HRAs for Health Risk Stratification
    • Disability Support for Dual Eligibles
    • Sources for Care Management Protocols
    • Measuring the Effectiveness of Case Management
    • PMPM Costs for Care Coordination
    • Reducing Readmissions through Care Transition Management
    • Qualifications for Care Coordinators and Managers
    • Overcoming Transportation Obstacles
    • Prospective Coding Assessments
    • Communicating with the Medical Home
    • Working with Complex Cases
    • Integrating Care For Duals
    • Locating Hard-to-Reach Duals
    • Home Visit Guidelines and Challenges
  • Glossary
  • For More Information
  • About the Speakers
Publication Date: March 2013
Number of Pages: 27
ISBN 10: 1-939167-14-0 (Print version); 1-939167-15-9 (PDF version)
ISBN 13: 978-1-939167-14-9 (Print version); 978-1-939167-15-6 (PDF version)
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