“The healthcare world is changing; providers who have been serving a certain population are now serving a completely new population, a more diverse population. When you talk about cultural competency, what you really need to look at is what the customs, beliefs and values of these individuals are.”

Dr. Terri Mack-Biggs, Geriatrician, Hospice of Detroit, Michigan

There is a significant demographic shift taking place in the United States, particularly for older adult populations. According to the Diverse Elders Coalition, the older population will grow far more diverse in racial, ethnic and cultural dimensions over the coming few decades, as the cohort of Americans age 65 and older doubles in size from 2010 to 2050. A particularly vulnerable population within this broad demographic shift is the Medicare-Medicaid enrollee population, sometimes referred to as “dual eligibles.” According to data from 2008, 61 percent of dual eligible beneficiaries are 65 and over. They have trouble navigating through these two complicated health care systems, often feeling lost in a maze of multiple doctors, medications and programs, and these challenges are often exacerbated for individuals from communities of color.

The Centers for Medicare and Medicaid Services’ financial alignment demonstration projects currently underway in more than a dozen states seek to integrate and coordinate care across Medicare and Medicaid for dual eligibles, and to redress many of the problems experienced in the current disjointed system.

Dual eligibles generally have poorer health status and account for a significant and disproportionate cost burden on Medicare and Medicaid, totaling more than $300 billion annually. People of color comprise 44 percent of the Medicare-Medicaid enrollee population, compared to 17 percent of the Medicare-only population. Diverse dual eligibles face a particularly great challenge in finding culturally and linguistically competent care.

A new paper by Community Catalyst examines provisions in the documents guiding the demonstration projects as they relate to addressing racial and ethnic health disparities and lays out a set of recommendations to move toward achieving health equity for dual eligibles. There is much work to be done. As Patrick Aitcheson of the Diverse Elders Coalition explains, “Equitably meeting the health care needs of diverse populations first requires gaining a deeper understanding of the range and richness of the cultural and linguistic groups you are serving. That is the necessary starting point for delivering culturally competent services.”

Findings from Community Catalyst’s survey of the dual demonstration project documents published to date reveal that while the addressing of health disparities is often present as a broadly stated goal, details of how this goal will be operationalized are largely missing. The paper makes recommendations in the following areas:

Cultural Competency in Care Delivery – The rapidly changing landscape calls for increased training of health care professionals and organizations to provide effective, high-quality care that is responsive to the very diverse cultural and linguistic needs of dually eligible beneficiaries of color.

Language Access – Implementing appropriate language access services can reduce barriers and create clearer pathways for dual eligibles to access the right services, which in turn can improve their health,   their satisfaction with the care they receive, and very often reduce costs by more efficiently connecting beneficiaries to the proper services for their needs.

Quality and Monitoring – Ongoing monitoring and development of appropriate quality measures can lead to a more effective demonstration project.

Consumer Engagement – Having representatives from communities of color participating in consumer engagement opportunities is  critical  to ensuring consumers receive the right services, at the right time in the right setting.

The Centers for Medicare and Medicaid Services, participating states, health plans and providers have a unique window of opportunity in these demonstration projects to improve care for dual eligible beneficiaries of color and point the way forward for the health care system more widely. But success will depend on these stakeholders taking concrete, targeted steps to address health disparities, as well as on strong ongoing involvement by consumers from communities of color and their advocates.