Updated May 23 at 11:16am

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Care system for dual-eligibility planned

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PROVIDENCE – The annual Policymakers Breakfast, hosted by Neighborhood Health Plan of Rhode Island and the Rhode Health Center Association, focused on the efforts to create an integrated system of care for the dual eligible population for Medicare and Medicaid, mandated under federal health care reform, with the goal of reducing costs and improving the quality of care.

More than 150 people – including policy and fiscal analysts from the General Assembly – attended the breakfast on Nov. 16 at the Roger Williams Park Casino, which featured a presentations by Elena Nicolella, associate director of the R.I. Department of Human Services, who oversees the state’s Medicaid program, and Tim Engelhardt, who directs the new federal Coordinated Health Care Office, Centers for Medicare and Medicaid Services (CMS), charged with improving the systems of care for those individuals who are dually eligible.

The problem, according to CMS, is “the financial misalignment” between Medicare and Medicaid. As a result, the majority of dually eligible beneficiaries receive their care in uncoordinated, fragmented and often confusing system.

In Rhode Island, nearly half of the entire state’s Medicaid budget in FY 2009 – $761 million ($367 from state funds), or 45 percent – was spent on about one-quarter – some 38,000 who are dually eligible – of the total Medicaid population. The reason is that many of the dually eligible individuals in Rhode Island have chronic illnesses, disabilities and mental health issues that, in an uncoordinated system, result in unnecessary, costly hospitalizations.

Nicolella plans to present a report to the R.I. General Assembly by the end of December that outlines a proposal for integrated, coordinated care for this dually eligible population. The new plan will seek to create a focus on the individual not the benefits, according to Nicolella, using patient-centered medical homes, better transitional care management, improved home services, and more accurate and better-managed data systems.

Depending on what action the General Assembly takes, and the resultant federal support for such a program, the new integrated health care system could be up and running by the end of 2012, according to Nicolella.

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