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White Paper From DST Health Solutions Assesses Opportunities In Emerging “Dual-Eligible” Healthcare Market

Millions of Americans Eligible for Both Medicare and Medicaid Are Migrating to Managed Care 

DST Health Solutions LLC, a provider of technology solutions and services to health plans, integrated delivery systems, and health care providers, has released a white paper on the next great opportunity for managed care plans: Serving the millions of Americans eligible for healthcare coverage through both the Medicare and Medicaid programs.

“Covering the Dual-Eligible Population: A New Frontier for Managed Care Organizations” — focuses on specific strategies that can help managed care plans improve the quality and cost-effectiveness of coverage for dual-eligible beneficiaries.

The paper indicates that approximately ten million of the most vulnerable people in the U.S. healthcare system qualify for coverage through both the Medicare and Medicaid programs. Many of these Americans  are migrating to managed care plans as state and federal agencies  implement strategies to restructure program costs to improve the quality of care for dual-eligible beneficiaries.

According to Teri Mullaney, President and CEO of DST Health Solutions, while the dual-eligible market presents great challenges to managed care plans, it offers unprecedented opportunity as well.

“Health plans can make a profound and positive difference in this country by focusing on a population that traditionally has not had the benefit of well-coordinated and well-managed care,” says Mullaney, one of the paper’s contributing authors. “Providers to this market segment have a chance to not only help control program costs, but also can improve the health and quality of life of dual-eligible beneficiaries at the same time. It really is a new frontier for managed care plans.”

The paper suggests that to succeed in the dual-eligible market, health plans, in addition to delivering excellent care coordination and care management services, must establish effective ways to better integrate and automate the coverage and administration of the two distinct health programs — Medicare and Medicaid.

“Migrating the dual-eligible population into managed care plans is a logical next step in the evolution of government programs,” said Thomas Scully, Senior Counsel at Alston & Bird LLP, and former Administrator of the Centers for Medicare and Medicaid Services.  “By some accounts, this change will yield more than $200 billion in new annualized premiums for health plans over the course of the next several years.”

DST has more than 35 years of experience working with government-sponsored health plans and has developed a comprehensive, technology-driven solution specifically designed to support dual-eligible plans. The company’s technology-based solutions enable dual-eligible plans and other managed care plans to streamline complex administrative tasks, improve care management for enrollees, enhance member services, and support Medicare-Medicaid program compliance.