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Options for Integrating Care for Dual Eligible Beneficiaries

Overview

There are nearly nine million dual eligible beneficiaries, and over 80 percent of these Americans remain in uncoordinated fee-for-service care. In order to provide these beneficiaries with the right care at the right time in the right places, The Center for Health Care Strategies, Inc. organized this technical assistance brief to discuss options for integrating care.

Key Points

Care integration for dual eligible beneficiaries can be grouped into four broad categories: Special Needs Plans (SNPS), Program for All-Inclusive Care for the Elderly (PACE), Shared Savings Models, and States as Integrated Care Entities. Regardless of the option developed, it is essential that it have a strong patient-centered care approach, multi-disciplinary care teams, a comprehensive provider network, increased use of home and community based services, robust data sharing, and strong consumer protections.

Option details include:

  1. SNPs: target dual eligible beneficiaries requiring an institutional level of care, and beneficiaries with chronic conditions.
  2. PACE: serves individuals who are age 55+, certified by their state to need nursing home care, are able to live safely in the community at the time of enrollment, and live in a PACE service area.
  3. Shared Savings Models: physician groups, integrated health systems, or regional coalitions join together and create a tailored alternative payment system to support integration of services for dual eligible beneficiaries on a fee-for-service basis.
  4. States as Integrated Care Entities: provides an opportunity to integrate the full range of Medicare and Medicaid benefits (e.g., primary, acute, behavioral health, and long-term supports and services) for dual eligible individuals beyond the SNP model.

How to Use

For all integration options, considerations, pros and cons are listed that can help state officials determine the applicability of each across the entire state, as well as regions within states, “depending upon the penetration of managed care, the sophistication of integrated health systems, the state’s capacity, and its engagement of consumer and provider stakeholders.” 

View the full report: Options for Integrating Care for Dual Eligible Beneficiaries (PDF – 394 KB)