New Survey Reveals Challenges Faced by Dual-Eligible Beneficiaries in Accessing Healthcare Services

A new survey conducted by Cityblock Health in collaboration with Ipsos sheds light on the difficulties faced by dual-eligible beneficiaries—those enrolled in both Medicare and Medicaid. This population, expected to grow by 6% annually and surpass 15 million by 2028, often encounters confusion due to navigating two distinct health plans with differing benefits. As a result, many struggle to access the essential healthcare services they need, leading to potentially serious health consequences.

According to the results of the study, significant numbers of dual-eligible individuals reported long wait times and challenges in accessing their healthcare. Among the 280 respondents, nearly one-quarter (24%) indicated they waited two weeks or longer for an appointment with their primary care physician. Additionally, almost 40% experienced delays of over 30 minutes for scheduled appointments. A noteworthy 20% of individuals found their healthcare hard to access, highlighting an urgent area for improvement.

The consequences of these barriers can be serious. Notably, 42% of those surveyed reported seeking care in an emergency room or urgent care facility at least once within the last year due to dissatisfaction with their primary healthcare experience. Furthermore, one-third (33%) admitted to delaying medical care at least once over the same period, often because of a negative interaction with the healthcare system. Alarmingly, a quarter (25%) of dual-eligible individuals stated that their lack of understanding regarding their health plans had led them to postpone seeking care.

In addition to physical health challenges, the survey revealed that mental health is a significant concern. Many dual-eligible individuals reported experiencing feelings of sadness, loneliness, and depression, with 54% feeling sad, 45% experiencing depression, and 42% facing loneliness on a monthly basis. Social determinants also impede their access to care; 28% indicated that transportation issues occasionally hindered them from receiving necessary medical services, while a staggering 69% reported that financial constraints affected their day-to-day lives.

Dr. Toyin Ajayi, CEO and Co-founder of Cityblock Health, emphasized the need for improved care models for the dual-eligible population. "With nearly two in three dual-eligible patients struggling with their health on a daily basis, it's evident that we must focus on creating a consistent and effective healthcare experience for these individuals. Unaddressed barriers not only lead to delayed care but also create costly consequences such as unnecessary emergency room visits."

Cityblock Health served 100,000 Medicaid and dual-eligible individuals in 2024 alone, utilizing a scalable approach aimed at engaging members through all stages of their healthcare journey. This survey’s findings support the organization's commitment to improving care for this vulnerable population through integrated health services.

The survey and its findings underline existing gaps within the healthcare system that affect dual-eligible individuals' access to care and overall health experiences. Cityblock's President, Mike Roaldi, highlighted the vital opportunity for health plans and providers to address these needs, particularly in light of new CMS requirements that will impact how dual-eligible plans transition to more supportive frameworks.

As the discussion about healthcare access and quality continues, the results of this survey are more than just numbers; they represent the ongoing struggles faced by millions and the urgent need for comprehensive support. For further details regarding the survey's findings, Cityblock Health has published a comprehensive report.

Cityblock Health stands at the forefront of transforming care for Medicaid and dual-eligible recipients, emphasizing their commitment to a holistic approach that addresses clinical, behavioral, and social needs. The organization’s ability to integrate technology with care management ensures that individuals in this challenging healthcare landscape can receive tailored support.

To learn more about Cityblock Health and their approach, visit their website at www.cityblock.com. The survey's complete findings and methodologies can be accessed in the State of Dual-Eligible Health Experiences report.

Topics Health)

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