Integrating care for Medicare-Medicaid enrollees through managed fee-for-service (FFS) models offers a new opportunity for states to improve service delivery and benefit from savings that can result from improved quality and more effective service use in both Medicare and Medicaid. This technical assistance brief reviews primary care case management and related FFS models to gather insights into key program design elements needed to manage care for high-need, high-cost beneficiaries with multiple conditions. Well-designed managed FFS programs will have a clear vision of integration implemented through an accountable entity capable of bringing together the fragmented pieces of the FFS system, and making significant upfront investments in management, staff, and information systems. Other key program design elements include: (1) identification of high-need, high-cost beneficiaries; (2) use of a multidisciplinary care team; (3) comprehensive assessment of beneficiaries; (4) development of a person-centered care plan; (5) implementation of comprehensive care management interventions; (6) real-time information exchange; and (7) financial alignment.
This technical assistance brief is a product of the Integrated Care Resource Center made possible by the Centers for Medicare & Medicaid Services. The Integrated Care Resource Center is a national initiative to help states improve the quality and cost-effectiveness of care for Medicaid’s high-need, high-cost beneficiaries. The state technical assistance activities provided within the Integrated Care Resource Center are coordinated by Mathematica Policy Research and the Center for Health Care Strategies.