In Arizona, as well as nationwide, vulnerable individuals and their health care providers share in a very big problem:
- For vulnerable patients, the problem is that lack of Medicaid and Medicare Advantage enrollment frequently makes quality healthcare unaffordable.
- For health care providers, lack of patient’s Medicaid and Medicare Advantage enrollment makes critically needed revenue unobtainable.
The cause of both problems is one and the same. The “dots” that comprise the patient–provider–payer system are frequently disconnected.
This white paper explores the dimensions of the problem and proposes a dot-connecting solution.
Impact On The Senior Population
The problem of the disconnected Medicaid dots is particularly acute in the senior (age 65+) population. Vulnerable elderly patients are receiving (only) about one-half of the care that their healthcare providers recommend for them (Source: Rand Corporation).
This situation is the result of five converging challenges: 1) an exploding senior population, 2) pervasive poverty, 3) deteriorating health, 4) massive confusion over Medicare, Medicaid and Medicare Advantage benefits, and 5) safety net and rural providers not getting paid.
1. The Exploding Senior Population
The population of age 65+ Americans is exploding, both in Arizona and nationwide. According to AARP, on average, 10,000 Americans are turning age 65 every day.
2. Pervasive Poverty
The exploding senior population is poor. Kaiser Family Foundation reports that, during 2016, half of all Medicare beneficiaries had an annual income of less than $2,183 per month, and one-quarter had an annual income of less than $1,271 per month.
3. Deteriorating Health
As seniors age, their need for healthcare increases.
The National Council on Aging reports that:
- Approximately 80% of older adults have at least one chronic disease and 77% have at least two.
- Diabetes affects 23% of the Americans aged 60+
- 90% of Americans age 55+ are at risk for hypertension, or high blood pressure.
4. Massive Confusion
Most seniors find taking advantage of Medicare and Medicaid benefits both confusing and daunting:
- In October 2018, Weiss Ratings (a consumer research and advisory service) published a report titled Over 50% of Seniors Say the Medicare Process is Confusing.
The report noted that “More than 50% of seniors enrolling in Medicare during Open Enrollment find choosing the right plan confusing . . . Add in the process of choosing a supplemental plan, to cover some of Medicare’s ‘gaps’ like co-payments, deductibles and other out-of-pocket costs and now it’s even more daunting.”
- A July 2017 article in the Huffington Post observed that “Medicaid is the nation’s single largest insurance provider, yet millions of Americans are seemingly unaware of what it does and who it serves.”
5. A Liquidity Crisis
Many safety net and other rural and critical access hospitals and clinics are challenged to collect the Medicaid and related private insurance revenue that they need in order to continue providing quality care to uninsured and underinsured seniors.
- The Health Inc. article Rethinking Rural Health Solutions To Save Patients And Communities (February 2018), reports that, across the U.S., 673 rural hospitals are at risk of closing, with 210 being at extreme risk. In addition, 60 rural hospitals did close between 2010 and February 2016.
- The American Hospital Association estimates that payments from Medicare and Medicaid lagged provider’s costs by $76.6 billion during 2018.
- Healthcare bankruptcy filings have soared in recent years as measured by the Polsinelli TrBK Health Care Services Distress Index. The Index reports that, versus its 2010 benchmark year, bankruptcy filings in the healthcare sector nearly quadrupled as of the third quarter 2019.