Nurse listening to chest of patient in home

Medicare and Medicaid dual-eligibles are utilizing emergency departments and home healthcare at twice the rate of Medicare-only enrollees, according to a recent study by long term care advisory firm ATI Advisory.

Kimberly Smathers, ATI Advisory’s managing director, told McKnight’s Home Care Daily Pulse these often medically complex patients with high rates of social needs are falling through the cracks because they aren’t covered by the right types of plans. Half of the nation’s 12 million dual-eligibles have access to integrated health plans for Medicare and Medicaid beneficiaries, but only about 7% are enrolled in them.

“Plan products may not be coordinating across the typical Medicare services,” Smathers explained. “With the system being very confusing, it can be very hard to select the right plan or even understand if the plan is integrated.” 

The ATI Advisory report comes just two weeks after the Medicare Advisory Payment Commission (MedPac) report to Congress found dual-eligibles used more services on average than the overall Medicare population.

The ATI study found that dual-eligibles tend to have higher barriers to social determinants of health (SDOH), such as transportation, safe housing, food and internet access. However, a higher percentage of that cohort [54%] is enrolled in Medicare Advantage plans, which increasingly offer supplemental benefits that address SDOH. However, ATI Advisory analyst Laura Benzing pointed out those benefits are often too limited to provide any meaningful help to the enrollee.

“An MA plan will have about $36 per member, per month to spend on supplemental benefits and this gets split over dental, vision, hearing, meals, transportation,” Benzing said. “It’s a great opportunity to meet some of those gaps in care needs, but it’s a small portion of the pot.” 

Since MA plans currently serve more than half of the dual-eligible population, the study said those plans have an “unprecedented opportunity to support the unique needs” of the group. ATI Advisory suggested MA plans consider the impact of dual beneficiaries as the plans play an important role in the outcomes of those patients.