ACAP Dual Eligibles Toolkit Summary Data for Washington
Washington state has approximately 100,000 full duals, with the majority being aged 65 and above. The annual costs for full duals amount to around $300 billion, with a significant portion covered by Medicaid. Special Needs Consulting Services (SNCS) estimates that only 7% of duals costs in Washington are paid via capitation. The state plans to participate in CMS Capitation Alignment Demonstration, presenting opportunities for care coordination and market positioning for interested MCOs.
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Presentation Transcript
ACAP Dual Eligibles Toolkit: Summary Data for Washington Compiled by: Special Needs Consulting Services (SNCS)
Key Information, Washington Washington has roughly 100,000 full duals 55% of these persons are age 65+ The full duals annual costs (across Medicaid and Medicare) now total approximately $300 billion roughly $50,000 per person per year 53% of these expenditures are paid for by Medicaid SNCS estimates that 7% of the Washington duals costs are currently paid via capitation; 93% via FFS Washington plans to participate in CMS Capitation Alignment Demonstration, with initial enrollment effective January 2013 MCOs interested in serving duals under this demonstration need to engage in significant preparations during CY2012 (and CY2013) Average lifetime revenue for each dual eligible enrolled is likely to approach or exceed $500,000, since most duals will remain eligible and enrolled for remainder of their lives (which should average > 10 years) The high needs and high costs, coupled with the rest of life enrollment dynamic, creates profound and exciting care coordination opportunities Moving Washington s duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup
Estimated PMPM Cost, Washington Full Duals, 2008 Washington Age <65 Age 65+ All Full Duals Average Eligibles 44,612 55,040 99,652 Total Medicaid Cost $1,012 $1,372 $1,211 Nursing Home $105 $619 $389 Capitated Care $6 $14 $11 HCBS Waiver & Prosthetics $644 $473 $550 Personal Support $113 $181 $151 ICF/MR $5 $1 $3 All Other Medicaid $139 $83 $108 Estimated Medicare Costs $1,004 $1,095 $1,055 Part A $275 $401 $345 Part B $299 $404 $357 Part D $430 $290 $353 Total Costs, Medicaid & Medicare $2,016 $2,467 $2,265
Estimated Total Dollar Cost, Washington Full Duals, 2008 Washington Age <65 Age 65+ All Full Duals Average Eligibles 44,612 55,040 99,652 Total Medicaid Cost $541,613,743 $906,302,205 $1,447,915,948 Nursing Home $56,106,952 $408,815,929 $464,922,881 Capitated Care $3,234,664 $9,511,323 $12,745,987 HCBS Waiver & Prosthetics $344,568,083 $312,669,018 $657,237,101 Personal Support $60,594,136 $119,465,407 $180,059,543 ICF/MR $2,851,304 $926,022 $3,777,326 All Other Medicaid $74,258,604 $54,914,506 $129,173,110 Estimated Medicare Costs $537,740,496 $723,351,095 $1,261,091,591 Part A $147,390,334 $264,729,150 $412,119,485 Part B $160,134,955 $267,154,442 $427,289,397 Part D $230,215,207 $191,467,503 $421,682,710 Total Costs, Medicaid & Medicare $1,079,354,239 $1,629,653,300 $2,709,007,539
Publicly Available Resources Containing Data and/or Other Information About Washington s Dual Eligibles Medicare-Medicaid Enrollee State Profile, Washington, Centers for Medicare & Medicaid Services http://www.integratedcareresourcecenter.com/PDFs/StateProfileWA.pdf Invitation to Provide Public Comment, Pathways to Health: Medicare and Medicaid Integration in Washington State http://www.aasa.dshs.wa.gov/duals/ Achieving Optimal Care Coordination for Medicaid/Medicare Dual Eligibles, August 2011, Special Needs Consulting Services (Joel Menges, Jeremy Batt, Kaleigh Beronja, Jessica Wiecezak) http://www.sncservices.com/Achieving%20Optimal%20Care%20Coordination%20fo r%20Dual%20Eligibles-%20FINAL.pdf
