More than 10 million Americans are dually eligible for Medicare and Medicaid, but due to program misalignments these beneficiaries often receive fragmented, uncoordinated care. In 2011, the Centers for Medicare & Medicaid Services (CMS) created the Financial Alignment Initiative to test new models to integrate Medicare and Medicaid for this population. Under the initiative’s capitated model demonstrations that began in 2013, CMS and states contract with Medicare-Medicaid Plans, which are responsible for the full range of covered services for dually eligible beneficiaries.
This report, prepared by CHCS for the Association for Community Affiliated Plans (ACAP), examines the experiences of 14 ACAP plans that are participating in the demonstrations. CHCS interviewed these plans to identify innovations advanced under the demonstrations, as well as lessons for integrating care for dually eligible individuals. Innovations discussed in the report are grouped around six key themes:
- Supporting individuals in the community by addressing housing and other social determinants of health, and reducing institutional care;
- Coordinating care delivery across various providers and services;
- Identifying unmet needs;
- Engaging providers across the continuum of care;
- Coordinating physical and behavioral health; and
- Exploring alternative payment models to improve value and accountability.
The lessons and breakthroughs of the ACAP health plans captured in this report can help guide additional health plans, as well as states, in designing effective and replicable strategies to improve care for dually eligible individuals.