Author: Sam Fish | Posted: 27. July 2012 06:00
Various media articles recently have raised questions about current efforts by states and the federal government to enroll individuals eligible for both Medicare and Medicaid into managed care, citing states’ and plans’ lack of experience in delivering integrated care to this vulnerable, complex population. Since its 1982 inception, Arizona’s Medicaid program has required all participants to enroll in a Medicaid managed care plan. In addition to participating in Arizona’s Medicaid managed care program, the Mercy Care Plan, which is fully administered by Aetna, also operates as a Medicare Advantage dual eligible special needs plan (DE-SNP), providing Medicare and Medicaid covered services, including acute, long-term care, and pharmacy services to over 16,800 dual eligible beneficiaries. Approximately 23% of the Mercy Care dual eligible population receive long-term care, and 5% are developmentally disabled.
Mercy Care uses interdisciplinary teams, including physicians, pharmacists, nurses, and behavioral health specialists, to support intensive case management programs that are tailored to individual members. Although benefits are financed from two different programs—Medicare and Medicaid—the plan has organized an integrated approach to simplify navigating the two systems. A study of the Mercy Care model provided evidence of decreased hospital utilization, including lower inpatient and emergency room utilization and readmission rates.
