IMPAQ International. (2021). Using Human Centered Design to Understand the Experiences of Dually Eligible Individuals: Lessons from Lived Experience. Hafner, M., Farrar, B., Johnson, K., Pedersen, S., Allen, K., Fish, T., Pirzada, F.
Individuals who are dually eligible for both Medicare and Medicaid experience challenges with care delivery and integration because they tend to have greater health needs and lower income than other Medicare beneficiaries. This report and the underlying research help to fill a significant gap in the literature by focusing on the views and experiences of dually eligible individuals and advocates, and hence is an invaluable resource for identifying strategies to improve Medicare and Medicaid program alignment.
How we Conducted This Study
We used principles of Human Centered Design (HCD) to conduct an exploratory study of the ways in which integration across the Medicare and Medicaid programs, or lack thereof, affects the care experiences of dually eligible individuals. We selected the HCD approach because it provides a framework and set of tools for understanding complex, dynamic, and ill-defined challenges, such as the complex health and health-related social needs of dually eligible individuals.
What we Learned
- Although nearly half of the dually eligible individuals in our sample are enrolled in integrated care plans, they experienced similar challenges with obtaining and coordinating necessary care and services as those who were not enrolled in integrated care plans.
- Their concept of care is oriented toward whole-person, comprehensive care. In their responses, individuals stressed that they desire and value care that is compassionate, collaborative, and inclusive of all aspects of life and well-being.
- Dually eligible individuals perceive integrated care as less of a continuum and more of an ecosystem that encompasses their personal circumstances, including family, health, social, and logistical needs.
- Integrated care begins with access to a network of high-quality providers.
- Appropriate and timely prescribing and fulfillment of prescriptions are key components of integrated care.
- Transportation was a frequent problem in accessing care. Without it, certain services are effectively out of network.
- Telehealth mitigated certain challenges associated with receiving integrated care, such as arranging for transportation and getting timely appointments.
- Individuals need help to understand, navigate, and coordinate their benefits to receive integrated care.
Considerations for State and Federal Policy
Our findings identify important considerations for designing integrated plans and systems:
- Dually eligible individuals have a range of medical and behavioral health as well as social needs. Helping this population likely is not accomplished through plan design alone, but through hands-on approaches to identifying their needs and getting them and their families connected to care and services.
- Individuals’ needs are closely tied to their personal goals and family circumstances. When plans and providers meet individuals where they are and understand these needs and goals, they can collaborate more effectively to improve the individual’s health and well-being.
- Provider networks play a key role in dually eligibles’ experiences of integrated care. Primary care physicians with a strong emphasis on care coordination, integrated health systems, and group practices with co-located services help individuals receive integrated care.
- Dually eligible individuals need help identifying what benefits and services are available to them. Proactive, knowledgeable navigators or case managers who routinely communicate with dually eligible individuals can work with the individual in a way that respects and preserves their autonomy and preferences.