Despite a cancelled flight, losing my cellphone and an overly flirtatious hotel concierge, there was one undeniable benefit from the Medicaid Congress I recently attended: getting the skinny on the emerging dual-eligibles demonstrations. Dual-eligibles are those who receive both Medicare and Medicaid benefits, and the demonstrations are designed to improve care coordination and cost-effectiveness for this population. But are they really demonstrations?
Skepticism ran high at the conference. Multiple speakers expressed concern that the demos are more like waivers, and that they are trying to do too much too soon. Whereas demonstrations usually start with small control groups, some states are going big. Phase one of California's demonstration will include more than half a million people in four counties. Another point made by conference speakers is that demonstrations are meant to be like laboratories, where approaches are tested and results analyzed before next steps are taken. Yet California intends to launch demonstrations in four additional counties within six months of the first pilots going live.
The good news is that California has re-thought its approach. The launch date has been pushed back and some segments including those with end-stage renal disease have been excluded from the demonstration.
Another great reveal from the conference was that state-specific profiles for the dual-eligibles population will be available. These first-ever profiles now available at the CMS website include demographic, utilization and spending data. And more data is something these demonstrations desperately need in order to succeed.
In the grand scheme, the duals demonstrations are hardly happening too soon. The unique needs of this high-cost population have been ignored for too long. But now that the wheels are turning, can these demonstrations be stopped, particularly if the grand experiment yields less than grand results
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