Integrated Medicare-Medicaid models are associated with less institutionalization, greater home- and community-based service use, and reduced mortality.
Background
People who are dually eligible for Medicare and Medicaid frequently have complex health care needs and often face significant barriers to care. Integrated care models — such as Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), and Program of All-Inclusive Care for the Elderly (PACE), among other models — seek to improve care for dually eligible enrollees by aligning and coordinating Medicare and Medicaid benefits. Integrated care models vary by program design, population, and degree of benefit integration and administrative alignment. This report examines the impact of D-SNPs, FIDE-SNPs, and PACE programs on health care service utilization and outcomes for enrollees.
Findings
This study used 2015 Medicare data to compare health care service utilization and outcomes for people enrolled in integrated care models (D-SNPs, FIDE-SNPs, and PACE) with people enrolled in non-integrated Medicare Advantage health plans. All three types of integrated care models were associated with reduced institutional use, and D-SNPs and FIDE-SNPs were associated with greater home- and community-based service use. D-SNPs and FIDE-SNPs were associated with reduced mortality and PACE had no significant impact on mortality. Impacts to hospital and emergency department (ED) use was more varied. D-SNPs and FIDE-SNPs were associated with greater ED use, while PACE was associated with less ED use. D-SNPs and PACE were associated with less hospital use, while FIDE-SNPs were associated with greater hospital use.
Program/Policy Takeaways
Integrated care models can enable more cost-effective home- and community-based services and improved health outcomes among dually eligible individuals. However, more research is needed to understand whether increased ED and hospital use in some models indicate unmet health care needs. Policymakers may explore how to expand access to and refine design of integrated care models.
