Authored by: Mark Feinberg, Managing Partner, Chief Executive Officer
The emergency department (ED) plays a crucial role in providing acute care to individuals with diverse healthcare needs. Among the patient population seeking emergency care, a significant subset comprises dual eligibles. Dual eligibles are individuals who qualify for both Medicare and Medicaid, representing some of the most vulnerable and complex patients in the healthcare system.
Challenges faced in providing care to dual eligibles in the ED
- Complex medical conditions. Dual eligibles often present with multiple chronic conditions, which can complicate their care. These conditions require a comprehensive understanding of their medical history, medication management, and coordination with other healthcare providers involved in their care.1
- Social determinants of health (SDOH). Dual eligibles frequently experience social determinants of health, such as low socioeconomic status, limited access to transportation, inadequate housing, or food insecurity. These factors contribute to their overall health outcomes and require attention and coordination with community resources to address their social needs.2
- Fragmented care and lack of continuity. Dual eligibles may receive care from multiple providers and healthcare systems, leading to fragmented care and limited care coordination. This lack of continuity can result in disjointed care plans, medication errors, and communication gaps among providers, compromising patient outcomes.3
- High utilization of emergency services. Dual eligibles often rely on the ED as their primary source of care due to various barriers, such as a lack of or limited access to primary care providers, lack of health literacy, or transportation challenges. This high utilization places a strain on ED resources and may hinder the provision of timely care to all patients.4
Opportunities for improved care
- Care coordination and interdisciplinary collaboration. Implementing care coordination models that involve interdisciplinary collaboration among healthcare providers, social workers, and community organizations can help address the complex needs of dual eligibles. Coordinated efforts can ensure seamless transitions between care settings, effective medication reconciliation, and access to appropriate community resources.5
- Enhanced communication and health information exchange. Improving communication and health information exchange between different providers involved in the care of dual eligibles is essential. This can be achieved through interoperable electronic health records, standardized care plans, and secure communication platforms. Timely and accurate information sharing helps prevent duplication of tests, reduces medical errors, and improves care coordination.6
- Integration of social services. Recognizing the impact of social determinants of health, EDs can collaborate with community organizations and social service agencies to provide support for dual eligibles. This may include assistance with transportation, access to affordable housing, food assistance programs, and referrals to mental health or substance abuse services. Integrating social services within the ED environment can address social needs and enhance the overall well-being of dual eligibles.7
- Patient education and health literacy. Offering tailored patient education programs that consider the health literacy levels of dual eligibles can empower them to actively participate in their own care. Clear and accessible educational materials, culturally sensitive communication, and support in navigating the healthcare system can improve health outcomes and promote self-management.
Providing care to dual eligibles in the ED poses unique challenges due to their complex medical conditions, social determinants of health, fragmented care, and high utilization of emergency services. However, there are significant opportunities to improve care through care coordination, interdisciplinary collaboration, enhanced communication, integration of social services, and patient education. Tailored approaches that address the specific needs of dual eligibles can lead to improved health outcomes, enhanced patient experience, and more efficient use of healthcare resources. Implementing these strategies requires a commitment from healthcare organizations, providers, policymakers, and community stakeholders to collaborate and develop systems that prioritize the comprehensive care of dual eligibles. By recognizing the challenges faced by dual eligibles and seizing the opportunities to enhance care delivery, we can work towards a healthcare system that provides equitable, coordinated, and patient-centered emergency care to this vulnerable population.
- Centers for Medicare & Medicaid Services. (2021). Medicare-Medicaid Enrollee State Profiles. Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Enrollee-State-Profiles
- Garg, A., Jack, B., & Zuckerman, B. (2019). Addressing Social Determinants of Health: Challenges and Opportunities in a Value-Based Model. Health Affairs, 38(8), 1366-1374.
- Lipsitz, L. A., & Berry, W. R. (2011). Understanding Health Care as a Complex System: The Foundation for Unintended Consequences. Journal of the American Medical Association, 306(9), 1012-1013.
- Dusetzina, S. B., Keating, N. L., & Huskamp, H. A. (2014). The Impacts of Eliminating Drug Caps on Medicare Beneficiaries. Journal of General Internal Medicine, 29(1), 160-166.
- Bodenheimer, T., & Berry-Millett, R. (2009). Care Management of Patients with Complex Health Care Needs. The Synthesis Project, Robert Wood Johnson Foundation, 19, 1-6. Patel, U. B., Akinsola, O., Evans, D. C., Khatri, U., Rees, M., & Zhang, W. (2019). Improving Communication in the Emergency Department: A Systematic Review and Practice Recommendations. Journal of Healthcare Quality, 41(3), 139-149.
- Gottlieb, L. M., & Hessler, D. (2018). Longitudinal Advantages of Patient-Centered Medical Homes in Addressing Social Determinants of Health. Journal of General Internal Medicine, 33(10), 1752-1754.
- Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of Internal Medicine, 155(2), 97-107.