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Impacts of COVID-19 on Care Management in the Dual-Eligible Population

COVID-19 has highlighted weaknesses in our healthcare system and shone a spotlight on fault lines, especially for the most clinically and socially vulnerable like the dual-eligible special needs populations (D-SNPs). Those who are dually eligible for Medicare and Medicaid are amongst the sickest and most clinically complex with more than half of this population having significant medical, behavioral health, and long-term care needs. These health issues along with social risk factors like poverty, food insecurity, housing instability, and lack of transportation have been disproportionately magnified for this cohort during the pandemic.

Some of the most challenging aspects of healthcare including gaps in care, a highly fragmented system, and lack of coordination between Medicare and Medicaid have worsened as a result of COVID-19. According to the Center for Health Care Strategies, data examined across every demographic category finds that dually eligible individuals are more likely to contract or be hospitalized for COVID-19 than Medicare-only beneficiaries. In the dually eligible beneficiary cohort, hospitalizations with COVID-19 related complications were tracked at a rate more than four times higher than Medicare-only beneficiaries according to the data.

For those health plans serving D-SNP programs, a technology platform for end-to-end care management and population health is critical. Platforms like HealthEdge’s GuidingCare enable plans to deliver a customized model of care that not only meets the needs of a D-SNP population but also enables the plan to be compliant with state and federal regulations. The right D-SNP managed care platform can:

  • Create automated and customized care plans
  • Manage compliance reporting accurately and efficiently for all required activities
  • Schedule and perform interdisciplinary care team meetings
  • Leverage social determinants of health (SDOH) connections
  • Improve member engagement
  • Enable easy updates for changing state and federal regulation requirements

GuidingCare is a next-generation care management platform that meets all these needs and more.  For health plans serving D-SNP populations, GuidingCare has a proven track record for meeting the needs of this challenging population. HealthEdge is fluent in the needs of state-sponsored programs serving the most vulnerable and high-risk populations. The GuidingCare platform integrates with both findhelp and Healthify to seamlessly connect members with services they need to address SDOH challenges. Plans that rely on GuidingCare can maximize coordination and member engagement for improved STAR ratings, better health outcomes, and increased member satisfaction.

Now more than ever, the challenges and demands on health plans serving the D-SNP populations is even more emphasized and urgent – at both the state and federal level. These health plans must adopt an efficient and effective care management platform, not only to meet the needs of its population, but also to remain competitive.

Hear from Jennie Giuliany, RN, HealthEdge’s Lead Clinician, Client Management and GuidingCare client Commonwealth Care Association in the April ACAP webinar.