At the 2024 National Association of Medicaid Directors (NAMD) conference, healthcare leaders, state officials, and policy experts came together to tackle a pressing issue: how to improve care and sustainability for dual-eligible individuals—those who qualify for both Medicare and Medicaid. This population, with high health and social needs, relies on a well-coordinated system to navigate complex healthcare services and access essential support. Managing these programs is no small feat, and states face substantial challenges.
This year’s NAMD conference highlighted four essential themes: data, capacity, shared savings, and the importance of partnership. Here’s what we learned about these pillars of success—and how CITIZ3N’s Verify platform can help states address these challenges.
1. Data: The Foundation of Effective Duals Programs
Reliable data is the backbone of any successful duals program. Without accurate, actionable insights, it’s challenging for states to manage care effectively, monitor outcomes, and make informed improvements. Massachusetts has made strides in this area, building a team of 15 dedicated staff who oversee data from numerous health plans, resulting in improved program oversight and increased trust in their data. This robust data foundation allows Massachusetts to make proactive, data-driven decisions.
On the other hand, states like Nevada, with just one person managing duals programs, struggle to conduct deep analysis due to limited capacity. These disparities underscore the need for advanced data solutions that enable states of all sizes to gather, analyze, and act on reliable insights. A solution like CITIZ3N’s Verify platform can empower states to build the trustworthy data foundations they need to improve program monitoring and outcomes.
2. Capacity: Investing in Resources for Sustainable Impact
Resource constraints are a universal challenge across duals programs. While Massachusetts has significant staffing, other states operate with smaller teams. In Nevada, the duals program is managed by one individual who juggles oversight and data analysis. Ohio has turned to American Rescue Plan Act (ARPA) funding to boost capacity, making critical program improvements despite limited resources.
Expanding capacity is crucial for sustainable impact. CITIZ3N’s Verify platform can help states maximize their existing resources by automating key processes like eligibility verification, freeing up staff to focus on strategic improvements rather than manual tasks. By supporting states with both high and low capacity, Verify can drive efficiencies and enable staff to deliver broader oversight and support.
3. Shared Savings: Reinventing Savings for Greater Program Impact
Shared savings—resources saved through improved care coordination and efficiency—is a powerful incentive for states to streamline duals programs. By reducing duplicative services and facilitating smoother care transitions, states can achieve significant savings. These funds can be reinvested into expanding services or adding program resources. Kelli Emans highlighted the importance of shared savings, emphasizing how they enable states to reinvest in program enhancements that ultimately improve the dual-eligible experience.
CITIZ3N’s Verify platform aligns with this approach by helping states reduce fraud, waste, and abuse (FWA) through robust verification processes. The resulting savings can be reinvested, strengthening program sustainability and directly benefiting the individuals served. In addition, Verify’s fraud prevention tools help protect program integrity, making it easier for states to achieve—and maximize—shared savings.
4. “Due Not Sue”: Building Collaborative Partnerships with Health Plans
As Medicaid and Medicare often overlap in providing services for dual-eligible individuals, effective collaboration between states and health plans is essential. In a humorous yet insightful comment, Maureen emphasized a “Due Not Sue” approach, reminding health plans that true partnership means working with states to co-develop solutions for dual-eligible populations. Health plans need to be as invested in consumer feedback and service improvements as states are.
To be effective, health plans must understand the unique needs of dual-eligible members and approach their care with a consumer-first mindset. This collaborative approach, based on transparency and shared responsibility, allows both states and health plans to create high-quality, consumer-centered programs that enhance the member experience.
With tools like CITIZ3N’s Verify platform, states and health plans can align more easily on care standards and goals. Verify supports transparency and accountability, helping build the strong, trust-based relationships needed for successful partnerships. For fee-for-service states, where Medicaid oversight remains high, Verify’s robust tracking and analytics capabilities provide a valuable resource to align health plan performance with state priorities.
How CITIZ3N’s Verify Platform Can Support States in Strengthening Duals Programs
The insights from NAMD 2024 highlight the essential pillars needed to transform duals programs and drive sustainable, high-quality care. CITIZ3N’s Verify platform is uniquely positioned to support states in addressing these challenges:
• Enhancing Data Accuracy and Availability: With advanced data capabilities, Verify helps states build reliable data foundations, supporting transparency, program monitoring, and actionable insights.
• Expanding Capacity with Automated Solutions: For states with limited resources, Verify fills critical gaps in eligibility verification and monitoring, allowing staff to focus on higher-value strategic tasks.
• Enabling Shared Savings: By minimizing fraud, waste, and abuse, Verify contributes to shared savings that states can reinvest into duals programs, reinforcing financial sustainability and program impact.
• Promoting Collaboration and Accountability: With transparency and accountability at its core, Verify aligns with states’ goals to foster strong, collaborative partnerships with health plans, supporting mutual commitment to high-quality care.
As dual-eligible populations grow, states face increasing demands to provide seamless, coordinated services that address complex health and social needs. By focusing on data, capacity, shared savings, and partnerships, states can build resilient, consumer-centered duals programs. With CITIZ3N’s Verify platform as a trusted partner, states can streamline care, strengthen oversight, and ultimately deliver better outcomes for dual-eligible individuals.
Ready to Learn More?
If your state is looking to strengthen its duals program, CITIZ3N is here to help. Contact us to learn more about how Verify can support your goals and help create a sustainable, high-quality program that meets the needs of dual-eligible populations.
