Dual-Eligible Care Management

From Managing Vulnerable Populations

This is an excerpt from our research briefing, Managing Vulnerable Populations.

This briefing explores strategies for improving care management for three distinct Medicaid patient populations: pregnant women, patients with chronic conditions, and dual-eligible patients, or those who qualify for both Medicare and Medicaid.

Design a Proactive Approach with a Multidisciplinary Care Team

The most complex patients also offer the biggest opportunity to make short-term quality and cost gains.

The whole process starts with a discussion with the patient. From there, build a plan that includes resources outside the clinic and be as consistent as you can in your communications to help establish continuity of care.

25%–40% of hospitalizations for this population could be prevented.Patients who are eligible for both Medicaid and Medicare are some of the most complex patients to treat. The organizations that are doing it right are building care teams that can serve both clinical and non-clinical needs. They’re also integrating these plans across the continuum, not just within episodes of care. This can help prevent duplication of tests or the tendency for unnecessary high-acuity care.

And even for those hospitalizations that can’t be prevented, we have the opportunity to reduce the inpatient burden.

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Executive Research Briefing

Managing Vulnerable Populations