Editing Medicare dual eligible (section)

== Research ==
A study by the [[Government Accountability Office]] (GAO) found that the integration of Medicare and Medicaid benefits generally improves the care provided to dual-eligibles but does not lead to Medicare savings or a reduction in costly Medicare services (i.e., emergency room visits, hospital admissions, and 30-day risk-adjusted all-cause readmissions). Medicare Advantage health plans that fully integrated Medicare and Medicaid benefits for dual-eligibles (i.e., FIDE-SNPs) generally had better quality of care scores (particularly for intermediate outcome measures) relative to plans with less integration of benefits. However, only FIDE-SNPs that operated in states with long-standing integration programs performed well on quality of care scores. While the care provided generally improved for dual-eligibles enrolled in FIDE-SNPs, very few of these plans reported lower estimated Medicare costs relative to what Medicare's fee-for-service program would have spent for beneficiaries with the same demographic and health characteristics. Furthermore, the FIDE-SNPs that reported potential Medicare savings generally did not demonstrate lower costs than other D-SNPs in the same geographic areas. These results were consistent for dual-eligibles both under the age of 65 and those age 65 and over. While operating specialized plans and integrating benefits could lead to improved care, GAO's results suggest that these conditions have not demonstrated a reduction in dual-eligible beneficiaries' Medicare spending compared with Medicare spending in settings without integrated benefits. Because the GAO study also found that the average number of costly Medicare services increases as the number of chronic and mental health conditions increase, it is possible that savings were not demonstrated because the population being served by FIDE-SNPs is too large to be cost-effective and major complications were averted for relatively few beneficiaries.<ref name=":2">{{Cite web|url=https://www.gao.gov/assets/670/665491.pdf|title=Disabled Dual-Eligible Beneficiaries: Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings|date=August 2014|website=United States Government Accountability Office}}</ref>

A study looking at physician's views of Medicare Part D, and in particular how it pertains to dual-eligibles, found that many physicians expressed concern regarding access to prescription drugs, especially for dual-eligibles. Almost half of physicians responded that the access to prescription drugs for dual-eligibles was worse under Part D than relative to the previous Medicaid, and more than half (63%) reported higher administration burden. Many physicians stated that dual-eligibles had less access under Part D than in three Medicaid restrictive states. This suggests that the transparency of Part D formulary coverage needs to be improved to improve access to these resources for physicians.<ref>{{cite journal |pmid=18991482 |year=2008 |last1=Epstein |first1=AJ |last2=Rathore |first2=SS |last3=Alexander |first3=GC |last4=Ketcham |first4=JD |title=Primary care physicians' views of Medicare Part D |volume=14 |issue=11 Suppl |pages=SP5–13 |journal=The American Journal of Managed Care}}</ref>{{Unreliable medical source|date=September 2011}}

A further study by the same group of researchers found that despite the above physicians' views on access to healthcare among dual-eligibles, there were no statistically significant changes in pharmaceutical utilization or [[out-of-pocket]] expenditures in the 18 months after Medicare Part D implementation. When comparing a group of dual-eligibles (the experimental group) with a control group of near-elderly Medicaid-covered patients, both groups showed a decline in costs rights after the implementation of Part D, which then leveled off. The expenditures for both groups tracked each other.<ref>{{cite journal |pages=133–51 |doi=10.1111/j.1475-6773.2009.01065.x |title=Impact of Medicare Part D on Medicare-Medicaid Dual-Eligible Beneficiaries' Prescription Utilization and Expenditures |year=2010 |last1=Basu |first1=Anirban |last2=Yin |first2=Wesley |last3=Alexander |first3=G. Caleb |journal=Health Services Research |volume=45 |pmid=20002765 |issue=1 |pmc=2813441}}</ref>{{Unreliable medical source|date=September 2011}}