Is Managed Care the Answer for Dual Eligibles?

Is managed care the answer for dual eligibles?

More and more persons with disabilities are among the growing number of dual eligibles, i.e. people eligible for both Medicare and Medicaid coverage.  Persons with disabilities are eligible for Medicare either because of age or their disability and are eligible for Medicaid because of the poverty that has been forced upon them. 

There are good arguments both for and against managed care for this population, as can be seen from this article in the LA Times:  http://www.latimes.com/news/local/la-me-healthcare-duals-20111114,0,3197520.story.

Whatever we do to make healthcare better for this population now, we need to be realistic about how this problem came about and decide how to prevent this in the future.  What we do now is focus on one aspect of policy at a time and try to put a bandaid on it.  What we end up with is an unwieldy and unworkable system. 

A disability policy that is based on current reality, that does not force persons with disabilities to live in poverty in order to obtain critical services is needed soon.  Current policy is so expensive the system is about to implode.  It is possible to have a policy that saves government many dollars and still improve the lives of persons with disabilities. 

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Primary Care and Healthcare Access

Another healthcare issue for persons with disabilities is physical access. 

Physical access goes beyond ramps and elevators.  It includes restrooms, exam rooms and any other room or space that is ordinarily accessed by patients.

There are standards for all accessible bathrooms put out by the Federal Access Board.

More recently, this same Federal Access Board has published guidelines for accessible healthcare facilities.  These guidelines include adequate space between and in exam rooms, accessible exam tables, lifts, scales and other equipment.  Almost no healthcare facilities meet these guidelines.

Primary care providers are the ones who see persons with disabilities the most, since they are in charge of coordinating all the other care.  Yet, these very same providers are paid the least and so are least able to afford the equipment needed by persons with disabilities.  This puts all of us who need this type of equipment at a disadvantage.

This is one more reason that this country needs to address the issues related to primary care.  No healthcare system, managed care, fee-for-service, or any other configuration, will work until we can provide stable, quality, accessible primary care.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

High Cost of Low Pay for Primary Care

Something for insurers to consider when setting reimbursement rates is that the shortage of primary care physicians plays a role in raising the cost of healthcare.

When there is no primary care physician available, people tend to go to the more expensive provider – emergency rooms.  While walk-in centers fill the gap for some, many walk-in centers do not take Medicaid, so persons with disabilities usually have to opt for the most expensive service available, simply because it is available.  This should be a real cause for concern since it means that people who use healthcare services the most are using the most expensive services.

This problem is not resolved by health centers and health systems if they have do not retain the same primary care providers.  This is because coverage and continuity of care are not interchangeable.  Coverage may be provided by new primary care physicians, but the time needed to develop the relationship that assures continuity of care is not there.  So, even with new good primary care physicians, the default option for some people will still be the emergency room.

Consider this – a person with a disability feels ill.  This person has not yet really connected with a  new primary care physician after his or her previous one has left a practice.  This person then faces the choice of calling a stranger (new but not yet established primary care doctor), and wait for a call back, with no certainty of whether or when that stranger will be available, or going to an emergency room where he or she will certainly be seen, even by a stranger.  For some disabilities, a minor problem can escalate to a major one quickly so the certainty of care will be the choice in almost every case.  This problem does not get resolved by the instant transfer of medical records either, since that transfer does not establish the relationship that is necessary for true continuity of care.

So, if paying primary care physicians less causes poorer healthcare delivery at a higher price it seems logical that Medicare, Medicaid and all other insurers should re-evaluate the reimbursement structure, looking at the bigger picture.

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude

Is Medicaid Collapsing?

Over the past 10 years, Medicaid enrollment across the 50 states has grown by approximately 50% according to a study by the Kaiser Commission. (http://www.kff.org/medicaid/upload/8050.pdf)    Of course the economy has contributed to this, as has the rise in health insurance costs, leading many employers to drop health insurance as a benefit.  However, disability policy has played a significant role in this as well.

Current disability policy dictates that persons with disabilities declare themselves unable to work and impoverish themselves in order to qualify for Medicaid, which will cover critical services that are not covered under private insurance policies.  The problem with this is that people who may be able to work are removed from the employment – and tax –rolls and become dependent on public support. 

In an economy that is as stressed as our current one is, this makes no sense.  To make matters worse, many states are now cutting the services provided, leaving many persons with disabilities with no recourse – No money and no support. 

There are programs that attempt to patch this system, but it’s like playing Whack-A-Mole.  A bandaid on one problem creates another problem in the system.  It’s time to face the reality that the current system is unsustainable. 

Building a new system from the ground up will require courage, but maintaining the status quo has no future. 

Annette Bourbonniere

www.accessing-ability.com

401-846-1960

Fax:  401-846-1944

Twitter:  @AccessInclude