Report examines incidence of preventable readmissions among dual-eligibles
Here's the intro: In 2008, about 8 million Medicare beneficiaries were enrolled in their states' Medicaid programs. For these dually eligible individuals, Medicaid pays for the Medicare premiums and other out-of-pocket expenses such as deductibles and coinsurance, and for Medicaid-only services such as long-term care. Dual eligibles tend to be among the sickest and poorest persons with complex health care needs. Prior studies revealed that compared with other Medicare beneficiaries, dual eligibles are more likely to be in poor health, have multiple chronic physical conditions, and have more than one mental/cognitive condition. On average, dual eligibles incur almost twice the level of total health expenditures (including Medicare, Medicaid, supplemental insurance, and out-of-pocket spending) as other Medicare beneficiaries. Overall, dual eligibles account for nearly half of all Medicaid spending and more than a quarter of all Medicare spending. Dual eligibles have been and will continue to be important to both federal and state public policymakers. Care for this population faces unique challenges due to split financial accountability between the two programs, diverse socio-demographic and clinical characteristics, and the related poverty and poor health of the population. These challenges create considerable difficulties for care coordination, which affects both access to care and the quality of care. Lack of access to care, poor quality of care, and inadequate management of health conditions, could lead to hospital admissions that are potentially preventable. Identifying conditions that are common reasons for potentially preventable hospitalizations would help guide development of strategies to improve care and patient outcomes while potentially lowering costs.
Source: Agency for Healthcare Research and Quality (September 2010)
Full report: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb96.pdf