The U.S. Office of Minority Health (OMH) released last Tuesday new public files on Socio-demographic and Health Characteristics of Medicare Beneficiaries Living in the Community by Dual Eligible Status in 2021. The data file provides aggregated demographic information with correlations to health status and chronic conditions, activities of daily living, mental health, and oral health data from Medicare-Medicaid beneficiaries.
This report is a sign of continued federal efforts to release valuable information regarding the social factors impacting healthcare for the Medicare population, which can help inform future policy and practice decisions. The data set from 2021 reveals some interesting details about the uniqueness of the dual-enrolled Medicare-Medicaid beneficiaries and their care delivery needs, compared to those who are not dual-eligible.
Overall, we learned that 26 percent of dual-enrolled members speak another language than English at home, compared to only 9 percent of the population that is Medicare-only. We also learned that over 40 percent of this population was classified as having fair or poor health, compared to only 18 percent of the Medicare-only group. When it comes to activities of daily living, those who were dually enrolled had greater difficulty with walking, bathing, getting out of bed, and dressing themselves than their counterparts, suggesting a greater need for additional supportive services. This also suggests further concerns regarding the progressive nature of poverty and one’s health status.
In looking at how Medicare beneficiaries were functioning in social domains, the impact of poverty was overwhelming in showing a significant decline in access to basic resources for those below the poverty line. A total of 42 percent of those who are 0-138 percent of the federal poverty level do not drive or have given up driving altogether.
This subgroup was also more likely to decrease meal size or skip meals altogether due to lack of access to food, reported at 40 percent. This group was more likely to have trouble staying up-to-date with their preventative healthcare and annual age-related vaccines, such as pneumonia, shingles, and flu. In looking at the neighborhood domain, this population was more likely to either be living alone or in an “other” type setting, likely a placement facility.
They were also significantly more likely to reside in a “disadvantaged” neighborhood, according to the Wisconsin Atlas neighborhood indicator. Not only does this population struggle with social domains, but they are also more likely to have four or more chronic conditions.
I think this report confirms some of the information we have already seen in our hospitals and EDs: that our patients are increasingly more socially and medically complex. Although details were listed in the report regarding patient data, at this time there were not further suggestions for care delivery models; however, I think we have already seen the release of additional funding support for care navigation and provider time to care for this population.
I would imagine that we will continue to see additional resources as we prepare to support the growing number of seniors in our Medicare population who will fall into the dual-enrolled group, as the data confirms their needs are significantly more complex and resource-limited.