Funder: The Commonwealth Fund and The SCAN Foundation

Author: Nancy Archibald and Alexandra Kruse, Center for Health Care Strategies

December 2015 | Technical Assistance Brief


State interest in models to better integrate care for individuals dually eligible for Medicare and Medicaid continues to grow. Integrating care across service settings and funding streams can potentially improve coordination of care, increase alignment of program benefits and administration, improve beneficiary experience of care, and reduce overall costs. States are using a variety of approaches to align incentives and reduce fragmentation of care delivery across the Medicare and Medicaid programs.

This brief, developed through support from The Commonwealth Fund and The SCAN Foundation, provides an overview of four integration models: (1) Dual Eligible Special Needs Plan (D-SNP)-based; (2) Financial Alignment Initiative-based; (3) the Program of All-Inclusive Care for the Elderly; and (4) accountable care organizations (ACO) and similar entities. It describes key features and considerations for each model. States exploring options to integrate care for dually eligible populations are encouraged to review these considerations through the lens of their program goals and unique health plan, provider, and consumer landscapes.