Expanding Opportunities for Providers to Coordinate Care for Dual Eligible Patients

Presently, there are an estimated nine million people, known as “dual eligibles,” who qualify for both Medicare and Medicaid. These individuals, considered the sickest and most complex patients in the health care delivery system, are often admitted for potentially avoidable reasons and consume a disproportionate share of hospital resources. Care fragmentation for this population not only worsens outcomes but also increases costs for health systems that do not properly manage their care. Unfortunately, budgetary constraints and misaligned financial incentives between Medicare and Medicaid result in the programs seldom working in tandem to improve care coordination for dual eligible patients.

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