ATI Advisory recently released an insightful report taking a fresh look at “partial duals” in Medicare Advantage. It is definitely worth a read. In it, ATI establishes that partial duals are a growing segment of the Medicare population as “the number of Medicare beneficiaries who are partial duals is growing faster than the number who are full duals, with overall growth rates of 10% and 6%, respectively, between 2015 and 2019.” With historical take-up rates for partial dual eligibles lagging those of full dual eligibles, perhaps these numbers are an early sign that some dual outreach programs are making an impact in helping get the word out about the Medicare Savings Programs.
Most importantly, the ATI report shows how the SDoH barriers and medical needs faced by partial duals are very similar to those faced by full duals. “Across each of the five social needs assessed in this report, partial dual beneficiaries experience rates of need similar to full duals” and “34% of partial dual beneficiaries had at least one emergency room (ER) visit in 2018, compared to 36% of full duals and 19% of Medicare-only beneficiaries.”
Source: “Advancing the Policy Environment to Address the Unique Needs of Partial Dual Eligible Beneficiaries” ATI Advisory. June, 2021.
The two categories that jump out to me there are food insecurity and likelihood of living alone – with the latter being a significant risk factor for loneliness or social isolation. (As discussed in a recent blog post by my colleague Keslie Crichton). With the majority of members who are eligible for partial dual status remaining unenrolled[i], these individual challenges point to a larger systemic failure. When partial dual eligible members are not enrolled they do not receive the benefits they need and there is no clear mechanism to identify these individuals as higher risk for these SDoH barriers. These members face significant social challenges which prevent them from living their healthiest lives. There are excellent programs available to members such as these (Including SNAP and food delivery services) but too often the members lack the information and assistance they need to enroll in these programs. As the authors point out the demographic characteristics of partial duals are fundamentally similar to those of full duals. As such, it is reasonable to assume that similar challenges prevent these members from being contacted by traditional outreach programs.
The solutions to these problems will not be simple. We join with ATI in encouraging CMS to provide additional assistance to these members, including enrollment in DSNPs and Supplemental Benefits.
There is also a role for Medicare Advantage plans to implement a wide-ranging and effective outreach plan to help eligible members enroll in the Medicare Savings Programs. Doing so helps the member in a variety of ways and has the additional benefit of securing additional, appropriate capitation for the MA plan – and meeting CMS guidance to implement dual eligible outreach programs. At BeneLynk, our management team has been doing dual eligible outreach since the early 2000s. We’ve built a new kind of outreach program, centered around human-to-human connection and designed to find eligible members traditionally ignored by dual eligible outreach programs.
I’m glad to see industry experts like ATI taking a deeper look at partial dual recipients. This population in many ways closely mirrors the full dual population but is frequently underserved in terms of benefit programs available to them, and in terms of participation in the programs that are available. I’m proud that our Dual Lynk™ services are part of the solution for millions of Medicare Advantage members, and look forward to doing more!
About the Author
Sean Libby has been an advocate for seniors, people with disabilities, veterans, and individuals with low income for over 19 years. At BeneLynk, we are committed to helping managed care plans to deliver superior Social Determinant of Health solutions to their members. We are always looking to learn more and would like to hear your ideas on how best to assist members in need. Drop us a note at Sales@BeneLynk.com.
[i] Source: MACPAC August 2017 Brief