High-performing health plans are critical to the success of efforts to align Medicare and Medicaid services, including the capitated financial alignment demonstrations as well as Dual Eligible Special Needs Plans. Yet, there is little consensus about what makes an integrated health plan high-performing.

This brief describes a framework outlining the characteristics of high-performing health plans. While the framework is intended as a guide rather than a set of formal criteria, it can help states and health plans establish the elements essential to successfully providing coordinated, person-centered, integrated care that meets the needs of individuals with complex needs.

Posted: June 2022