Promoting Integrated Care for Dual Eligibles

As states across the country advance new integrated programs for the approximately 11 million individuals who are dually eligible for Medicare and Medicaid, health plans are seeking strategies to better serve this high-need, high-cost population.

Through PRomoting Integrated Care for Dual Eligibles (PRIDE), made possible by The Commonwealth Fund, CHCS is helping health plans to further the viability and increase the impact of integrated care models for dually eligible beneficiaries. Participating plans include:

• BlueCare (Tennessee);
• CareOregon (Oregon);
• CareSource (Ohio);
• Commonwealth Care Alliance (Massachusetts);
• Health Plan of San Mateo (California);
• Independent Care Health Plan (iCare) (Wisconsin);
• UCare (Minnesota);
• UPMC for Life Dual (Pennsylvania); and
• VNSNY CHOICE Health Plans (New York).

In the current phase of the project, CHCS is working with leading health plans and their provider partners to implement innovative care delivery interventions including:

• Creating care management programs for individuals with serious mental illness;
• Improving communication and collaboration with primary care physicians;
• Developing incentives for home care providers to meet quality indicators;
• Facilitating transitions from nursing facilities to the community; and
• Providing wellness programs in senior housing.

The goals of the project are to: (1) support PRIDE plans and their partners in the adoption and implementation of promising care delivery models; and (2) spread actionable information about these innovations to new health plans serving this population as well as the broader health care system. CHCS provides participating health plans with opportunities for collaborative learning and direct technical assistance. Lessons from PRIDE are shared nationally.

Previous efforts under PRIDE focused on health plan strategies for finding hard-to-reach members, engaging providers, enhancing care management systems, addressing social determinants of health, and providing value-based care. Explore resources and tools at the links below.