Funder: The Commonwealth Fund and The SCAN Foundation

Author: Ann Mary Philip, Nancy Archibald, and Michelle Herman Soper, Center for Health Care Strategies

December 2016 | Brief


refining-integrated-care-duals

State Medicaid agencies have made considerable progress in implementing integrated Medicare-Medicaid programs to address the diverse needs of dually eligible individuals and better coordinate their care. Leading states are thoughtfully assessing what is and is not working, and making refinements based on their findings.

This brief, made possible by The Commonwealth Fund and The SCAN Foundation, highlights insights from states that are fine-tuning their integrated care programs. Formal evaluations of some integrated care programs are underway; however, until these results become available, the refinements made by states described in the brief — all participants in the Implementing New Systems of Integration for Dually Eligible Enrollees (INSIDE) project — can help others design their own integrated care programs to meet the beneficiary needs.

As identified by the INSIDE states, key priorities for refining integrated approaches include: (1) modifying care management models and requirements; (2) improving beneficiary understanding of coordinated care; (3) developing strategies to increase enrollment; (4) enhancing administrative alignment between Medicare and Medicaid program rules; and (5) supporting health plan sustainability.