Overview of Ohio's ACAP Dual Eligibles Toolkit Data
ACAP Dual Eligibles Toolkit:
Summary Data for Ohio
Compiled by: Special Needs
Consulting Services (SNCS)
Key Information, Ohio
•
Ohio has roughly 161,500 “full duals”
–
52% 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
–
65% of these expenditures are paid for by Medicaid
–
SNCS estimates that 7% of the Ohio duals’ costs are currently paid via
capitation; 93% via FFS
•
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 Ohio’s duals into coordinated care also makes market positioning
critically important for MCOs interested in serving this subgroup
Estimated PMPM Cost,
Ohio Full Duals, 2008
Estimated Total Dollar Cost,
Ohio Full Duals, 2008
Publicly Available Resources Containing Data and/or
Other Information About Ohio’s Dual Eligibles
•
Medicare-Medicaid Enrollee State Profile, Ohio, Centers for Medicare &
Medicaid Services
http://www.integratedcareresourcecenter.com/PDFs/StateProfileOH.pdf
•
Ohio, Dual Eligibles: State Health Facts, Kaiser Family Foundation
http://www.statehealthfacts.org/profileind.jsp?cat=6&sub=76&rgn=37
•
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%20Coordinat
ion%20for%20Dual%20Eligibles-%20FINAL.pdf
Ohio has approximately 161,500 full duals with significant annual costs totaling around $300 billion across Medicaid and Medicare. The care coordination opportunities for this population are profound, with MCOs needing to strategically position themselves. Preparations for serving duals under this demonstration are vital, as most enrollees are likely to remain eligible for over 10 years, generating substantial revenue. Various publicly available resources offer valuable insights into Ohio's dual eligibles.
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Presentation Transcript
ACAP Dual Eligibles Toolkit: Summary Data for Ohio Compiled by: Special Needs Consulting Services (SNCS)
Key Information, Ohio Ohio has roughly 161,500 full duals 52% 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 65% of these expenditures are paid for by Medicaid SNCS estimates that 7% of the Ohio duals costs are currently paid via capitation; 93% via FFS 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 Ohio s duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup
Estimated PMPM Cost, Ohio Full Duals, 2008
Estimated Total Dollar Cost, Ohio Full Duals, 2008
Publicly Available Resources Containing Data and/or Other Information About Ohio s Dual Eligibles Medicare-Medicaid Enrollee State Profile, Ohio, Centers for Medicare & Medicaid Services http://www.integratedcareresourcecenter.com/PDFs/StateProfileOH.pdf Ohio, Dual Eligibles: State Health Facts, Kaiser Family Foundation http://www.statehealthfacts.org/profileind.jsp?cat=6&sub=76&rgn=37 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%20Coordinat ion%20for%20Dual%20Eligibles-%20FINAL.pdf
