The capitation for “Dual-Eligible” or Medicare-Medicaid patients under Medicare Advantage can be as much as 30% higher than that of “regular” patients.
So why aren’t you doing better with them?
They’re not “sticky.”
They don’t stay with their PCP, often changing after only a couple of months.
They’ll also more vulnerable to illegal inducements to switch, often accepting payments to change primes or even insurers.
They’ll also more likely to be “slammed” or have scammers change their coverage fraudulently without them knowing about it.
It’s NOT because of their costs—you’re getting paid more because of their disease burden and health risks.
Create systems that allow them to deepen their relationships with their primes, such as more autonomy and financial risk-sharing. The patients will be less likely to switch even with inducements and your primes will have the incentive to watch their patient lists and, if they drop off, check for slamming.
There’s a great, simple tool from Cisne Health that helps primes identify the dual-eligibles they want to retain vs. the ones they can just let go if they do change PCPs
Dual-eligibles are an incredibly powerful tool for your Medicare Advantage success.
Create systems which support their ongoing care and you, your primes, and your patients can do very well indeed.