States working to integrate care for individuals dually eligible for both Medicare and Medicaid face several challenges in demonstrating how new integrated models improve the quality of care. These challenges exist whether the state is using a fee-for-service or a managed care model to improve care delivery. The Affordable Care Act's new opportunities to integrate care for Medicare-Medicaid beneficiaries heighten state and federal interest in identifying quality measurement approaches that address these challenges.
This brief from the Center for Health Care Strategies (CHCS) summarizes efforts to develop quality of care measures for Medicare-Medicaid enrollees. It provides guidance to states in developing measurement approaches for proposed integrated programs, including assessment of quality in specific domains of integrated care such as long-term services and supports and behavioral health services. It also describes how performance measures can be shaped by stakeholder input.This brief is part of CHCS' Technical Assistance for Dual Eligible Integrated Care Demonstrations program, made possible through The SCAN Foundation and The Commonwealth Fund. Through this program, CHCS is helping states develop and implement integrated-care models for individuals eligible for both Medicare and Medicaid services.