CMS: Dual Eligible Medicare Advantage Enrollees, Including in Nursing Homes, Received Worse Clinical Care
A Centers for Medicare & Medicaid Services’ Office of Minority Health (CMS OMH) analysis of Healthcare Effectiveness Data and Information Set (HEDIS) data found that the quality of clinical care provided to Medicare Advantage enrollees, particularly those dually eligible for Medicare and Medicaid and a low-income subsidy, was worse than that provided to those not enrolled in those plans. The HEDIS analysis covered 36 clinical care measures, including diabetes, cardiovascular disease, and chronic lung disease. According to a recent KFF report, 13% of dual enrollees lived in a long-term care nursing home or other institutional facility, and these patients often had intellectual or developmental disabilities and more limitations on their daily activities. CMS OMH said the greatest care disparities involved follow-up visits following a hospital stay for mental illness and medication interactions for residents prone to falls or receiving dementia care. Disparities also were more common with cancer screenings, mental illness care, care coordination, and an overuse or appropriate use of medication. However, CMS OMH said the COVID-19 pandemic likely played a role, especially in nursing homes and other long-term care settings. CMS OMH researchers said, “Additional research is needed to better understand the mechanisms that drive the disparities reported here. Such research would benefit from the use of a more nuanced measure of disability than the one used for this report (i.e., one that better captures the full conceptual definition of disability).”
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