To provide more integrated, coordinated care for its residents who are dually eligible for Medicare and Medicaid, Washington State is operating a demonstration under the Financial Alignment Initiative offered by the Centers for Medicare & Medicaid Services. This health home-based, managed fee-for-service demonstration carefully targets dually eligible beneficiaries with multiple chronic conditions and high costs. By engaging individuals in their care and focusing on the goals that matter most to them, health home care coordinators help enrollees to make meaningful behavior changes that improve health outcomes and reduce costs. While early evaluation results point to the effectiveness of this model, its long-term sustainability depends on the state’s ability to continue to access Medicare performance payments.
This case study, developed by the Integrated Care Resource Center, describes the structure of Washington’s demonstration, results achieved to date, and insights from the state and other stakeholders on the demonstration’s implementation.
State Medicaid agencies, particularly those looking to integrate care for dually eligible beneficiaries in non-capitated delivery systems, may find the information described in this brief useful.