The government is initiating an effort to redesign the delivery system for the dual eligible. Do you know much about and are you prepared for it? I hope the answer to both of those questions is yes, but if it is not, then I would like to shed some light on it for you.
There are several objectives they are trying to meet. Coordinate the care of beneficiaries covered by both Medicare and Medicaid, provide continuity of care, improve access and quality of care and save cost. Dual eligible patients are people who are fully eligible for both Medicare and Medicaid.
These patients will become managed care patients, which will present challenges that many of you may not have faced. In 2012, 26 states presented proposals of mainly 2 types, MFFS and Capitated. MFFS are where states provide coordinated care and get a share of any Medicare savings seen. Capitated is where the State and CMS pays a managed care organization a blended payment to provide Medicare and Medicaid services.
A small number of states will begin in 2013, but in 2014 things will pick up. You may not be in a Dual Eligible Initiative state, but managed care is going to become more and more prevalent and you will more than likely someday be faced with it. You better be prepared.
Some things to think about when preparing for managed care are, who has the contracts, what are the rates, what are the timelines associated with them. The first thing I would suggest if you are going to enter into contract talks, is to have a contract specialist that is equipped to look out for your best interest. This person is experienced in knowing the right questions to ask and what are reasonable answers to those questions.
Some things that will be different for SNF’s will be length of stay, with managed care it will be much shorter than you are accustomed to. The pace of everything will be accelerated. Everyone on your staff will have to be aware of the can do’s and can’t do’s of the contract. The communication between your staff will have to be on a high level.
I know that I have painted a less than rosy picture. I also have just touched on a few of the many things you will have to consider but this is enough to get you thinking about the hurdles that I feel you will face in the not too distant future.