Comparing Care for Dual-Eligibles Across Coverage Models: Empirical Evidence From Oregon

Hyunjee Kim, Christina J. Charlesworth, K. John McConnell, Jennifer B. Valentine, David C. Grabowski

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Dual-eligible beneficiaries or “duals” are individuals enrolled in both the Medicare and Medicaid programs. For both Medicare and Medicaid, they may be enrolled in fee-for-service or managed care, creating a mix of possible coverage models. Understanding these different models is essential to improving care for duals. Using All-Payer All-Claims data, we empirically described health service use and quality of care for Oregon duals across five coverage models with different combinations of fee-for-service, managed care, and plan alignment status across Medicare and Medicaid. We found substantial heterogeneity in care across these five coverage models. We also found that duals in plans with aligned financial incentives for Medicare and Medicaid experienced more improvement in their care relative to those with nonaligned Medicare Advantage and Medicaid managed care plans. These results highlight the importance of developing policies that account for the heterogeneity of the dual population and their coverage options.

Original languageEnglish (US)
Pages (from-to)661-677
Number of pages17
JournalMedical Care Research and Review
Volume76
Issue number5
DOIs
StatePublished - Oct 1 2019

Keywords

  • Medicaid
  • Medicare
  • care coordination
  • dual eligibles
  • plan alignment

ASJC Scopus subject areas

  • Health Policy

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