Funder: The Commonwealth Fund

Author: Nancy Archibald and Sarah Barth, Center for Health Care Strategies and Alice Lind, Washington State Health Care Authority

December 2015 |


More and more people who are dually eligible for Medicare and Medicaid are enrolling in integrated care programs such as the Medicare-Medicaid Plans in the capitated model financial alignment demonstrations and Fully Integrated Dual Eligible Special Needs Plans. Anecdotal evidence shows that integrated care is benefiting dually eligible enrollees; however, existing performance measures may not fully capture how these programs are improving people’s lives.

This brief details success stories from two health plans participating in PRIDE (PRomoting Integrated Care for Dual Eligibles), a national effort supported by The Commonwealth Fund. It examines the program elements behind these successes and the potential for existing measures — as well as measures currently in development — to accurately assess the performance of integrated care programs. States, health plans, and other stakeholders can use this information to refine their measurement strategies for programs serving dually eligible individuals.