Start: December 2013
Funder: The Commonwealth Fund
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.
ProfileFacilitating Community Transitions for Dually Eligible Beneficiaries December 2019
ProfileCoordinating Physical and Behavioral Health Services for Dually Eligible Members with Serious Mental Illness December 2019
Technical Assistance BriefProviding Value-Added Services for Medicare-Medicaid Enrollees: Considerations for Integrated Health Plans January 2017
ProfileHousing Options for High-Need Dually Eligible Individuals: Health Plan of San Mateo Pilot March 2016
BriefAssessing Success in Medicare-Medicaid Integration: A Review of Measurement Strategies December 2015
Technical Assistance BriefBuilding a Culture of Engagement for Medicare-Medicaid Enrollees: Health Plan Approaches August 2015
WebinarTargeting Interventions for the Highest-Need, Highest-Cost Medicare-Medicaid Enrollees: Health Plan Approaches July 2015
WebinarHealth Plan Approaches to Locating New Medicare-Medicaid Enrollees and Building Trusting Relationships January 2015
Technical Assistance BriefContacting Hard-to-Locate Medicare and Medicaid Members: Tips for Health Plans December 2014
BriefKey Attributes of High-Performing Integrated Health Plans for Medicare-Medicaid Enrollees August 2014