SOLUTIONS
A Personal, Accountable Approach
All people who are dually eligible should have a healthcare experience that includes access to a meaningfully integrated and easily navigable system of care that respects their choices and preferences, is high-value, and offers the same choices and options for care, regardless of where someone lives.
Principles for policy change include:
Every person who is dually eligible should have access to meaningfully integrated coverage.
Access is particularly critical for dual-eligible individuals who are eligible for the full range of Medicaid benefits in their state. Integrated coverage should more meaningfully align Medicare and Medicaid than it does today, which will increase efficiency and begin to address one of the biggest challenges in healthcare today: affordability. It should ensure that both government programs feel like one program. It should also allow people who are dually eligible to have all of their services covered under one program, which will make care more efficient. If a person’s physician, mental, and long-term needs are not well-coordinated, their coverage is not integrated.
People who are dually eligible should be provided with resources to ensure informed decision-making and enrollment in coverage are easy.
People who are dually eligible should have access to assistance in understanding their coverage options. This means making clearer descriptions available online and ensuring access to a neutral third party (i.e., someone who does not represent a managed care plan) to discuss their options. People should be permitted to remain enrolled in an integrated coverage option for a period of 12 months without having to be reassessed for eligibility in the program. Additionally, more should be done to prevent marketing tactics that confuse enrollees, rather than support their decision-making.
Integrated coverage must be held accountable for meeting people's needs and goals.
Integrated coverage options should be held accountable for the outcomes people care about. People who are dually eligible should also be given the flexibility to receive services that improve outcomes, including services that address needs like chronic disease prevention. People of color and individuals who experience serious mental health issues are disproportionately represented in the dual-eligible population—integrated coverage must address these issues. Another goal of the program should be to keep as many people connected to the communities in which they live as possible, consistent with their wishes.
