Dec 16, 2019
Individuals dually eligible for Medicare and Medicaid
(“duals”) represent a small but medically complex population, often with
functional limitations and unmet behavioral health needs. In many instances, this population must navigate
an uncoordinated set of benefits, eligibility criteria, providers, and
cost-sharing requirements. This fragmentation can lead to stress for the
individual and their caregivers, poorer health outcomes, and individuals
receiving incomplete care in inappropriate settings.
While these individuals represent only 20% of the
Medicare population and 15% of the Medicaid population, they make up 34% and
33% of each program’s costs, respectively. In 2012, Medicare spent $194 billion
on this population and Medicaid spent $119 billion, with 41% of the Medicare
dollars spent on outpatient care and 50% of the Medicaid dollars spent on
institutional long-term services and supports.¹
Dual Special Needs Plans (DSNPs)
Aligning the Medicare and Medicaid programs continues
to be a challenge for states and Centers for Medicare and Medicaid Services
(CMS); however, a key tool that states can use to facilitate this alignment and
contain costs is a Medicare Advantage Dual Eligible Special Needs Plan
(DSNP). Tailored to the unique needs of duals, DSNPs provide an
opportunity for managed care organizations to offer enhanced benefits and
streamline the experiences of duals as they navigate through multiple, complex
programs. Additionally, DSNPs provide states with flexibility to implement
programs based on the degree of Medicaid integration desired and state
priorities, as DSNPs can meet states “where they are” along the continuum of
integration and assist states in reaching their integration goals.
States can leverage the unique plan of care provided
through DSNP contracts to improve care management and provide a single source
of care coordination, simplify program experiences of duals, improve
provider-patient relationships, and reduce program costs. As of April 2017,
nearly 2 million individuals were enrolled in DSNP products across 43 states
and territories.
UnitedHealthcare currently serves over 900,000* dually
eligible individuals through our DSNP and FIDE SNP** products. In 2019, we
offer these specialized plans across 36 states and Washington, DC, and in 27 of
these states we enroll more duals than any other organization. We pride ourselves on our high-touch care delivery
models for this vulnerable population and focus on closing gaps in care,
including leveraging face-to-face community health workers and community
supports to address the socioeconomic needs of our members, as well as the
development of an individualized care plan that is shared with a member’s
interdisciplinary care team. This high-touch care extends to the home through
our call team as well as a nurse practitioner House Calls program we provide to
individuals identified as not accessing their primary care provider. Because of
our in-depth experience serving both the Medicare and Medicaid populations, we
are able to successfully coordinate care across the full spectrum of needs for
our dual members, including acute, behavioral health, and long-term services
and supports to meet functional needs.
UnitedHealthcare Community & State Medicaid
Offerings
¹Medicare
Payment Advisory Commission and Medicaid and CHIP Payment and Access
Commission. (2017). Joint Databook: Beneficiaries Dually Eligible For Medicare
and Medicaid.
²CMS Medicare Advantage/Part D Contract and Enrollment Data, SNP Comprehensive Report. April 2017.
*This number is inclusive of enrollees in both UnitedHealthcare Community & State and Medicare & Retirement DSNP markets.
** FIDE SNP is a Fully Integrated Special Needs Plan.
²CMS Medicare Advantage/Part D Contract and Enrollment Data, SNP Comprehensive Report. April 2017.
*This number is inclusive of enrollees in both UnitedHealthcare Community & State and Medicare & Retirement DSNP markets.
** FIDE SNP is a Fully Integrated Special Needs Plan.
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