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A pathway to full integration of care for Medicare-Medicaid beneficiaries
A pathway to full integration of care for Medicare-Medicaid beneficiaries
- Collection:
- Health Policy and Services Research
- Contributor(s):
- Bipartisan Policy Center, issuing body.
- Publication:
- Washington, DC : Bipartisan Policy Center, July 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated
Dual MEDICAID MEDICARE Eligibility
United States - Genre(s):
- Technical Report
- Abstract:
- BPC has worked for a number of years to improve integration of services for those who are eligible for Medicare and Medicaid. In continuing that work over the past year, BPC conducted research, hosted roundtable discussions, and interviewed key stakeholders to better understand the barriers to integration of these programs and the challenges faced by those who must navigate them. BPC also commissioned a study (see Appendix I) to better understand the challenges and successes of federal and state demonstrations to align these programs. The primary goals in recommending alignment are to improve beneficiary experience, outcomes, and well-being. Given the lack of coordination in the current system, BPC believes there is also potential for savings over the long term, primarily in the form of reduced hospitalizations, hospital readmissions, emergency department visits, and post-acute care. However, before those savings can be achieved, there will need to be up-front investments to provide resources to states and to the office within CMS that administers the program, to develop infrastructure where it is currently lacking. Finally, this proposal would guarantee a simplified and seamless integrated care option by a certain date. Efforts to better integrate care should recognize the heterogeneity of the dual eligible population, and the importance of a transition to integrated care for distinct populations. Dual eligible individuals should have comprehensive information about the benefits and drawbacks of enrolling in a fully integrated care model. There should be ample time for community-based education to help beneficiaries understand their enrollment options and the benefits available to them before they are enrolled in integrated care programs. Also, while these models should deliver a less complex and costly care experience, beneficiaries should be given the opportunity to opt-out of them at any time. BPC's recommendations are designed to create strong incentives to states to integrate care. The report identifies three care models from which states can choose to achieve full integration: (1) improved Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) that reflect lessons learned from the Financial Alignment Initiative (FAI) demonstration's Medicare-Medicaid Plans (MMPs); (2) the Programs of All-Inclusive Care for the Elderly (PACE); (3) a flexible model negotiated between the secretary of the U.S. Department of Health and Human Services (HHS) and a state, building off the managed fee-for-service model used by the State of Washington. Each model must cover all Medicare and Medicaid benefits and meet all integration requirements identified in this report. These recommendations are intended to build on best practices of the past 40 years in integrating care for full-benefit dual eligible individuals. These recommendations provide significant incentives to states in the form of planning grants, technical assistance, and guaranteed shared savings, if integration of services reduces costs over time. They also include provisions to help dual eligible individuals better understand the benefits and trade-offs of receiving care through a fully integrated plan, by providing federal resources for consumer education, and by recommending closer coordination between the Centers for Medicare & Medicaid Services (CMS) and the Administration for Community Living (ACL). To guarantee an integration option for all populations of dual eligible individuals in every state by a date certain, these recommendations include the framework for a federal fallback program to operate in states that choose not to integrate care. Under this approach, the secretary of HHS would contract with improved FIDE SNPs, which would be based on best practices from the FAI demonstration's Medicare-Medicaid plans. PACE would also continue to be available as an option. Over the last decade, stakeholders--including state and federal policymakers, consumer advocates, health plans, and providers--have worked to improve the complex challenges associated with improving care for those who rely on Medicare and Medicaid to address their health and long-term care needs. BPC is one of a small but growing group of organizations and agencies seeking to accelerate integration of care for dual eligible individuals. BPC does not hold a monopoly on good ideas and recognizes there are many paths forward. BPC welcomes the opportunity to work with policymakers and other organizations to identify viable solutions to improve care and lower costs for a vulnerable and high-cost population.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (68 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101778503 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101778503