In my last blog, I summarized the plan to move Medicare/Medi-Cal-covered patients residing in eight California counties into a system of coordinated care.  The move would make California the fifth dual-eligibles coordinated care project in the nation. In no particular order, the following demographics about plan enrollees worry me:

• One-in-two dual-eligible beneficiaries are cognitively/mentally impaired, compared to one-in-four of the other Medicare beneficiaries.
• One-in-two dual eligibles are in fair-to-poor health, compared to slightly more than one-in-five of the other Medicare beneficiaries.
• Slightly less than half the dual eligibles are nonelderly disabled, which is nearly four times the proportion of the other Medicare beneficiaries.
• One-in-two dual eligibles have less than a high school education, compared to one-in-five of the other Medicare beneficiaries.
• Lastly, 15 percent of the dual eligibles are long-term care residents, compared to just 2 percent of the other Medicare beneficiaries.

These demographics help explain why the dual eligibles representing only 16 percent of the Medicare population and 18 percent of the Medicaid population account for 24 and 46 percent, respectively, of the total expenditures for these programs.  So there it is; the motive behind the efforts of federal and state officials to move the dual eligibles into less costly, more efficient coordinated care programs. 

California’s local Medi-Cal managed care (MMC) plans to which the care for the dual eligibles will be entrusted have limited experience with these high-resource consuming beneficiaries.  The pressure to cut and control costs will shortchange the beneficiaries, their caregivers, or both, if state and federal officials do not provide the MMC plans with adequate funding and the time needed to build the right types of networks and care management protocols to manage this medically complex population.

A group of thought leaders I conferred with about my concerns suggested that final approval by the feds for this plan should come with independent monitors who have  Office of Inspector General-like federal powers to oversee the three-year project.  Paid for by the feds, the objective of this oversight feature is to ensure that course corrections are made as serious problems occur and before any of the more vulnerable patients get lost in the system, causing them to get sicker or die. 

Your thoughts?