Unclear regulations and a lack of experience managing risk for dual-eligible populations are holding payers back from developing plans for individuals eligible for both Medicare and Medicaid, executives for Belong Health write in an opinion for Health Affairs published Nov. 15.
Jordan Anderson, MD, senior vice president of care delivery for the dual-eligible plan-focused startup, and Gen Gillespie, chief revenue officer, said fewer than 20 percent of the 12.2 million people eligible for Medicare and Medicaid are enrolled in plans tailored to their needs.
The first reason for this, Dr. Anderson and Mr. Gillespie wrote, is unclear guidance from states. One way to solve this, they said, is for states to implement clear guidance on timelines and integration of dual-eligible special needs plans.
Payers also are hesitant to develop these plans because dual-eligible populations are more likely to be high users of healthcare services and have more complex conditions, Dr. Anderson and Mr. Gillespie wrote.
This can present challenges for analytics and actuarial teams when developing these plans, the authors said.
Read the full viewpoint here.