One of the many great characteristics of Federally Qualified Health Centers (FQHCs) is that they will serve anyone who walks through the door, regardless of their insurance status or ability to pay. Included in their scope of patients are dual-eligible beneficiaries (duals), or those who qualify for both Medicare and Medicaid. This group is often made up of lower-income seniors or disabled patients younger than 65, and typically they are high cost and high need.¹ Additionally, 60% have at least two chronic conditions.²
For Medicare and dual-eligible beneficiaries alike, with two or more chronic conditions, the Centers for Medicare & Medicaid Services (CMS) offers Chronic Care Management (CCM) as an evidence-based framework for enhancing care delivery. Chronic Care Management delivered through telehealth may also decrease trips to the hospital or emergency room, with studies already showing improved outcomes:
In a study measuring how telehealth in particular can improve chronic disease management, it was found that patients using telehealth for six months spent half as much time in hospital beds than before the six months. Additionally, an 81 percent decrease in emergency department visits was observed within the same time span.³ CCM has proven to be an effective solution for those with chronic conditions, it’s time for FQHCs to review this option for their dual-eligible patients.
One trend with duals is that their care accounts for a disproportionate amount of health care spending when compared to the amount of individuals utilizing dual eligibility. For instance, duals make up 20 percent of Medicare beneficiaries, but they account for 34 percent of the spending.⁴ And for certain services, health care spending is almost three times higher for duals than for others.⁵
“Despite the challenges inherent in serving such vulnerable populations, FQHCs’ success in providing access to high quality, cost-effective health care is well documented,” said Brad Wright, an associate professor at the University of Iowa who holds a PhD in health policy and management.⁶
Certintell partners with FQHCs, empowering them to offer Care Management services, such as CCM, to duals with two or more chronic conditions. CCM focuses on changing the typical behaviors of patients using health coaching, asynchronous secure messaging and more.
¹ Kelly, Logan, and Nancy Archibald. “Improving Care for Dually Eligible Beneficiaries through Innovative Health Plan Partnerships.” Center for Health Care Strategies, CHCS, 13 Aug. 2018, www.chcs.org/improving-care-for-dually-eligible-beneficiaries-through-innovative-health-plan-partnerships/.
² “People Dually Eligible for Medicare and Medicaid.” Centers for Medicare and Medicaid Services, CMS, Mar. 2019, www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf.
³ Patient Provider Telehealth Network – Using Telehealth to Improve Chronic Disease Management. NORC, 2012, pp. 1–11, https://www.healthit.gov/sites/default/files/pdf/RCCHCandPHS_CaseStudy.pdf
⁴ “Medicare Spending Growth for Dual-Eligible Beneficiaries Has Trended Down Since 2011.” Commonwealth Fund, 7 Aug. 2018, www.commonwealthfund.org/publications/journal-article/2018/aug/medicare-fee-for-service-spending-dual-eligibles.
⁵ Heath, Sara. “Most Medicare Dual-Eligibles See Social Determinants of Health.” Health Payer Intelligence, Xtelligent Healthcare Media, LLC, 1 Aug. 2019, healthpayerintelligence.com/news/most-medicare-dual-eligibles-see-social-determinants-of-health.
⁶ Wright, Brad. “Who Governs Federally Qualified Health Centers?.” Journal of Health Politics, Policy and Law vol. 38,1 (2013): 27-55. doi:10.1215/03616878-1898794