Improving the quality and cost-effectiveness of publicly financed health care
Options for Integrating Care for Dual Eligible Beneficiaries
As states are increasingly looking to integrate Medicaid and Medicare services for people who are dually eligible, this policy document developed by CHCS summarizes options for integration. Annual costs of caring for the nine million Americans who are dually eligible are estimated at $250 billion -- equaling half of all Medicaid and a quarter of all Medicare expenditures. Integrating care offers tremendous potential to both improve care and control costs for this population.
Through The SCAN Foundation, CHCS developed this resource per a request from the California Department of Health Care Services to support discussions around the state's 1115 Medicaid waiver development. The document outlines options for integration in four broad categories: 1) Special Needs Plans (SNPs); (2) Program for All-Inclusive Care for the Elderly (PACE); (3) Shared Savings Models; and (4) States as Integrated Care Entities. The document suggests that these options must include the following core elements to provide beneficiaries with the right care at the right time: strong patient-centered care; interdisciplinary care teams; provider networks capable of meeting a full range of patient needs; enhanced use of home- and community-based services; robust data sharing; consumer protections; and financial alignment that supports integration.
This resource offers a valuable reference for other states looking to integrate Medicare and Medicaid services to deliver higher-quality and more cost-effective care for this vulnerable population.
Integrating Care for Dual Eligibles: An Online Toolkit
This publication is part of CHCS' Integrating Care for Dual Eligibles Toolkit designed to share innovative approaches for integrating Medicaid and Medicare services. It offers policy-related materials, hands-on tools to help guide state efforts, and resources from states that have successfully implemented integrated programs.