Deborah Bachrach Discusses Dual Eligibles
"Dual Eligibles Represent an Opportunity for Your Patience"Managed Care Contracting and Reimbursement Advisor
July 1, 2012 - Manatt's Deborah Bachrach, a special counsel in the firm's Healthcare Division, spoke to Managed Care Contracting and Reimbursement Advisor about "dual eligibles," healthcare patients who are eligible for both Medicare and Medicaid.
The publication reports that the Centers for Medicare & Medicaid Services has encouraged states to experiment with ways to control spending on dual eligibles, a group that makes up 15% of the Medicaid population but 39% of its spending and 21% of Medicare's enrollment but 36% of the program's spending. Many states are moving dual eligibles to managed care, which will have several effects on physicians' offices.
Physician practices will be at the center of any effort to reduce the costs of dual eligibles because all of the coordinated care models-patient-centered medical homes, for instance, or enhanced physician care management-rely on the physician to be effective, said Bachrach.
"There will be more pressure and presumably more dollars ﬂowing to physicians," Bachrach said. "There also will be more demands for accountability."
States may choose to funnel dual eligibles through managed care plans, which will raise some of the same contracting issues that physicians typically encounter. But in addition, Bachrach added, there will be pressure to keep the patient independent enough to live in the community rather than in a nursing home.
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