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Commentary

Medicaid Advantage: A Medical Home for Dual-Eligibles
Robert B. Helms, Ph.D., Grace-Marie Turner, Galen Institute, 11-7-06

Turner and Helms argue that Medicaid needs a new program that can "integrate acute and long term care benefits for dual-eligible beneficiaries into a single program."

Our most vulnerable citizens—those dually eligible for Medicare and Medicaid—often fall into a fragmented care delivery system that perpetuates episodic rather than coordinated care. Patients may have difficulty accessing the medical care they need. And information about their care and their needs can be scattered among providers and facilities facing two different payment systems and sets of program rules.

Because physicians and others treating these patients donít have the patient's complete medical profile, patients can face gaps as well as duplication in treatments with no medical home responsible for optimizing their care.

To assure that Medicaid patients are receiving quality care, Medicaid must adopt new systems with better incentives to design more flexible and more effective care management programs for these recipients, especially those with disabilities and significant chronic illnesses. Having a medical home is central to this process. A comprehensive program that integrates Medicare and Medicaid coverage into a new integrated Medicaid Advantage plan would allow providers to focus on the best way to design and provide benefits to these beneficiaries with the right care in the right setting, rather than spending time on complying with rules for different payment systems. Significant efficiencies and better outcomes could be achieved through a comprehensive approach to providing health care for these Medicare and Medicaid–eligible beneficiaries.



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