Funder: The Commonwealth Fund
Author: Michelle Herman Soper, Center for Health Care Strategies
January 2017 | Technical Assistance Brief
Health plans integrating Medicare and Medicaid services may choose to provide additional “value-added” services for their dually eligible members, many of whom often have complex clinical conditions and functional limitations — as well as other social service and non-health related needs. Health plans are not paid to provide these additional services, but offer them in anticipation of improving members’ health outcomes and addressing social determinants of health.
This new brief, made possible by The Commonwealth Fund, explores how health plans participating in the PRIDE (Promoting Integrated Care for Dual Eligibles) project are: (1) addressing members’ service needs that are beyond the scope of traditionally covered Medicare or Medicaid services; (2) assessing the value of offering these services; and (3) allocating these services equitably across members. The brief also examines policy issues related to providing value-added services to Medicare-Medicaid enrollees in integrated care programs.