Perspectives: Keeping Health Care Costs from Going Awry: Care Coordination is a Key

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Sadly for most vulnerable older Californians, their first interaction with long-term services and supports (LTSS) begins in the emergency room. A recent report from California’s Medicaid Research Institute (CAMRI) shows that this perspective is particularly true for individuals covered by Medicare and Medi-Cal. Most people who used Medi-Cal-funded LTSS started these services after an emergency room visit, hospital admission, or rehabilitation stay. Older adults entering these institutions may experience additional health complications, be discharged with less function than when they entered, and find their support system at home less prepared to meet their needs.

Date Updated: 04/29/2014

In 2009, The SCAN Foundation in partnership with the state Department of Health Care Services brought together all sources of payment data for Californians eligible for both Medicare and Medi-Cal. The goals were to understand the needs and service use of this population better to know what works and what doesn’t in care delivery. This new report gives a much clearer understanding of the system inefficiencies and more importantly, missed care delivery opportunities. The findings point toward opportunities to use the state’s limited resources in different ways that might better support this population’s health and daily living needs.

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This is the third report coming from the California Medicaid Research Institute (CAMRI) project entitled: Comprehensive Analysis of Home- and Community-Based Services in California. The report describes Medicare and Medi-Cal spending for those beneficiaries using long-term services and supports funded by Medi-Cal.

The California Medicaid Research Institute (CAMRI) developed an integrated and longitudinal database containing Medi-Cal and Medicare claims and assessment data of LTSS recipients in California in 2008. CAMRI’s integrated database provides a unique opportunity to look at characteristics and program spending across the entire care continuum for beneficiaries with LTSS needs within Medi-Cal and for dual eligibles across Medicare and Medi-Cal. This report focuses on LTSS use and spending in the eight duals demonstration counties.

On March 27, 2013, the State of California and the Centers for Medicare and Medicaid Services (CMS) formalized a Memorandum of Understanding (MOU) to establish a Federal-State partnership to implement the Dual Eligibles Integration Demonstration, also referred to as Cal MediConnect. This Fact Sheet provides background information about Cal MediConnect and summarizes the key points of the MOU.