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Realizing The Promise Of Integrated Care For The ‘Dual Eligibles’


October 22nd, 2012

One of the highest priorities in the Affordable Care Act (ACA) is care delivery transformation for Americans enrolled in both Medicare and Medicaid, known as “dual eligible beneficiaries” or sometimes simply “duals.” This priority is embodied in federal-state demonstration programs currently gearing up. It is imperative that we resist calls to delay these initiatives and that we rapidly bring to scale the innovations that have already been shown to improve care for the duals at my own organization, Commonwealth Care Alliance, and elsewhere.

This is not the first time that Congress has sought to address the unmet needs and high costs of these individuals. Nearly 40 years ago, Congress expanded Medicare eligibility to non-elderly individuals with disabilities; legislators simultaneously expanded the scope of Medicaid’s community-based long-term care benefits to make Medicaid our nation’s preeminent disability and long term care insurer. The goal then, as now, was to promote appropriate medical care as an alternative to hospital care and independent living as an alternative to institutional care.

Yet today, less than 1 percent of dual beneficiaries are enrolled in integrated medical and long-term care delivery models designed to meet their needs. As a consequence, far too many individuals with disabilities have their goals of independence and autonomy subverted because of functional decline that is mostly preventable. Far too many frail elders and younger individuals with disabilities are routinely hospitalized because of a failure to effectively intervene to address a predictable and treatable array of complications of their underlying chronic illnesses.

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