Analysis Examines Shifting Financing of Care for Dual Eligibles From Medicaid to Medicare; Study Details Effects of 2005 Missouri Medicaid Cuts; Commentary Discusses Pay-for-Performance

• "Rethinking Medicaid's Financing Role for Medicare Enrollees," Kaiser Family Foundation's Commission on Medicaid and the Uninsured/Urban Institute: The analysis examines the national and state impacts of shifting from Medicaid to Medicare the financing of certain services for low-income beneficiaries who are dually eligible for the programs. According to the analysis, consolidating aspects of this financing at the federal level could provide relief to states and create new opportunities for improved care management and coordination for dual eligibles. The analysis also examines several options that collectively could provide as much as $47 billion annually in savings to states. In addition, the Kaiser Family Foundation has issued a brief with the latest available data on the total Medicaid enrollment and spending attributable to dual eligibles, with state-level estimates available in interactive tables and maps at the Foundation's statehealthfacts.org site. The Foundation also has updated a fact sheet that describes dual eligibles and examines the role Medicaid plays for this population and current policy challenges (Kaiser Family Foundation release, 2/13).
  
  
• "Missouri's 2005 Medicaid Cuts: How Did They Affect Enrollees and Providers?," Health Affairs: In the report, which was commissioned by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, researchers at the Urban Institute examine the effects of cuts made in 2005 to Missouri's Medicaid program in response to serious budget shortfalls. According to the study, after the cuts were enacted, the number of uninsured people in the state increased, hospitals faced greater demand for uncompensated care, and community health centers faced funding shortfalls that led them to reduce staff, increase patient fees (Zuckerman et al., Health Affairs release, 2/18).
  
  
• "Transformation of Health Care at the Front Line," Journal of the American Medical Association: In the commentary, physicians Patrick Conway and Carolyn Clancy write that "pay-for-performance, value-driven health care and public reporting of quality and cost information" have been promoted as a solution to the rising costs of the U.S. health care system. However, many "frontline physicians are exposed to disparate pay-for-performance programs" that are not coordinated and not "clearly aligned with producing better outcomes for patients," Conway and Clancy write. The authors conclude that in order to increase "clinician engagement" and improve patient care there must be an investment in "key drivers" such as quality measurement and comparative effectiveness; more effort by physicians to improve frontline care; an increased focus on payments for high-quality care; and a "champion" to emerge for a "transformation of care" who can bring together stakeholders and build "the requisite capacity and infrastructure" (Conway/Clancy, JAMA, 2/18).