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Groups Forming Consortium of Plans That Cover Dually Eligible Beneficiaries

By Rebecca Adams, CQ HealthBeat Associate Editor

December 5, 2012 -- States that are testing out ways to shift dually eligible patients into managed care could get some guidance from a new consortium of health plans being put together by the Visiting Nurse Service of New York with support from The Commonwealth Fund.

The project, known as Promoting Integrated Care for Dual Eligibles, was mentioned in a presentation at a conference in Washington sponsored by the National Committee for Quality Assurance last week. Carol Raphael, the former chief executive officer of the Visiting Nurse Service of New York, said that the goal is to finalize the members and launch the consortium in the first quarter of 2013.

Officials from the health plans would discuss challenges and solutions for such issues as building adequate networks, aligning plan and provider interests, engaging consumers and growing membership, she said.

Medicare and Medicaid together spend about $300 billion annually to care for about nine million dually eligible beneficiaries, and many states are interested in integrating their benefits. An office within the Centers for Medicare and Medicaid Services that coordinates care for dually eligible people has encouraged more coordinated and integrated care.

But many of the existing plans that cover them are relatively small and do not appear to routinely share information.

"There are some jewels but they tend to be small jewels," Raphael said of the plans.

The Commonwealth Fund has provided $318,084 for the first 15 months, from May 2012 through the end of July 2013, to get the project started.

The project team will work with other groups, including the Center for Health Care Strategies, which is working with states to develop integrated systems of care, and the National Committee for Quality Assurance, which is developing performance measures for integrated care models for dually eligible patients.

The new alliance plans to hold at least two meetings, regular conference calls, and webinars next year.

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