Ambulatory care for individuals dually eligible for Medicare and Medicaid

Individuals dually eligible for insurance through both Medicaid and Medicare ("duals") have more comorbidities, higher costs, and poorer outcomes compared to other groups. Unfortunately, policy and care redesign initiatives suffer from limited knowledge about ambulatory care patterns among duals.

Using 2022 Medicare fee-for-service claims and other sources of clinician and geographic data, we described care patterns for ambulatory services among dual vs non-duals. Our sample consisted of 967 820 dual and 4 600 486 non-dual individuals receiving a total of 67 122 906 ambulatory services from 106 545 practices and 815 827 clinicians.

We found that duals received fewer ambulatory, in particular subspecialty, services than non-duals, while duals received slightly more services through primary care physicians and advanced practice professionals. Among duals, most services were provided in office rather than federally qualified health centers or rural health clinics by a disproportionally small number of geographically dispersed practices and clinicians. High-dual practices and clinicians differed from non-high dual counterparts with respect to multiple characteristics.

These differences highlight the opportunity to improve access and outcomes among duals by targeting policy and practice changes toward certain groups and clinicians.