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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Heath care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Medicaid Council Reports on Study that Finds Dual Eligibles Can Hurt Medicare Advantage Ratings

January 9, 2014 02:59 PM

Inovalon recently published a study titled “The Impact of Dual Eligible Populations on CMS Five-Star Quality Measures and Member Outcomes in Medicare Advantage Health Plans.” Inovalon collected information on beneficiaries from 80 Medicare Advantage (MA) contracts.  Specifically, the study looked at 1.33 million MA enrollees from 2011, and 1.61 million MA enrollees from 2012, comparing the dual population with the non-dual population in each year. 

The highlights from the 2012 data are discussed below.

Duals have lower quality measures

Inovalon took an in-depth look at ten CMS Five Star Quality Measures.  Five of these were Healthcare Effectiveness Data and Information Set (HEDIS) Admin measures and five were Prescription Drug Event (PDE) measures.  These ten measures were chosen as scores can be calculated using available administrative claims data.    

The ten measures were:  

  1. Breast Cancer Screening;
  2. Diabetes Treatment;
  3. Glaucoma Testing;
  4. High Risk Medication;
  5. Medication Adherence for Cholesterol (Statins);
  6. Medication Adherence for Hypertension (RAS antagonists);
  7. Medication Adherence for Oral Diabetes Medications;
  8. Osteoporosis Management in Women who had a Fracture;
  9. Plan All-Cause Readmissions; and
  10. Rheumatoid Arthritis Management.

The study found that dual eligibles scored lower than the non-duals on 9 out of 10 of these quality measures, with the exception of Diabetes Treatment.  The only measure that was risk adjusted was Plan All-Case Readmissions, which used the National Committee for Quality Assurance (NCQA) risk adjustment model for MA members aged 65 and older.  This adjusted for case mix severity for first time hospital visits.  These factors included: age, comorbidities, discharge condition, gender, and presence of surgeries.

Lower scores on quality measures have significant repercussions.  The star rating system forms a basis for a pay-for-performance element of MA, as plans that obtain at least three stars receive higher payment rates.  According to John Gorman, an insurance consultant, plans can earn anywhere from $15 to $50 per month per enrollee per additional half star earned.  Therefore, lower star ratings translate to no bonuses.  Plans are denied much needed funds to administer medically complex enrollees like dual eligibles. 

A downward “spiral” can result: plans that have dual eligibles receive poor ratings, which denies them bonus payments, which in turn makes them less likely to enroll more duals.  Dan Rizzo, Inovalon’s CIO, stated that this negative incentive could be so strong that plans will stop offering MA altogether in some areas.  For details, click here

The study found additional characteristics of duals, discussed below.

Duals utilize equal numbers of office visits, more ambulatory visits

The study found no statistical significance on the difference in the percentage of the comparative populations receiving at least one office visit, with 94.4% of duals receiving at least one office visit compared to 94.8% of non-duals.  However, the difference in ambulatory visits was statistically significant: duals received an average of 17.3 visits, while non-duals received only 13.0 visits.  Ambulatory visits are outpatient visits to a hospital, which can include minor surgery, by non-resident patients of the hospital. 

Duals are more medically complex

The vast majority of both duals (97%) and non-duals (close to 100%) in the data set did not have institutional status.  Institutional status refers to MA beneficiaries that had spent 90 days or more in a long term care facility, such as a nursing home.  Compared with less than 1% of the non-dual population, 60% of duals were in an SNP plan.  Disability was a greater reason for duals’ entitlement to MA, at 35 % of the population, versus only 13% of non-duals.  Age was the primary reason for non-duals’ entitlement to MA, at 87% compared to 65% of the duals population.  Also, a greater percentage of duals had high (4 out of 5, or 5 out of 5) Charlson Severity Scores, as well as high CMS MA Risk Scores (1.000 and higher).

Duals are more economically vulnerable

A greater percentage of duals earned income of less than $25,000 (20 percent versus 4 percent), and 76 percent received a drug subsidy as compared to only 3% of the non-dual population.      

For a link to the full study, click here.


The National Council for Medicaid Home Care – a NAHC affiliate - supports sound policy for dual eligibles in MA plans, including opposing passive enrollment for dual eligibles.  For details, see page 47 of The Council’s policy blueprint, here

Quality incentives in MA should be designed smartly to ensure that plans are not penalized for taking on additional risk in the form of more complex enrollees.  The Council calls on Congress to revise the star rating system with this in mind.

Home care providers are encouraged to keep abreast of developments regarding dual eligibles on CMS’ website, and to contact the Council with any questions or concerns.




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