Evaluations of Integrated Care Models for Dually Eligible Beneficiaries: Key Findings and Research Gaps from MACPAC
August 08, 2019:
Under contract to the Medicaid and CHIP Payment and Access Commission (MACPAC), researchers at SHADAC recently compiled an inventory of evaluations of integrated care models for beneficiaries enrolled in both Medicare and Medicaid, for which both the inventory itself and a related issue brief have now been published.
About the Study
Currently, both the federal government and numerous states are testing a variety of models to integrate care for beneficiaries enrolled in both Medicare and Medicaid, including the Program of All-Inclusive Care for the Elderly, the Financial Alignment Initiative (FAI), Medicare Advantage dual eligible special needs plans and fully integrated dual eligible special needs plans, managed long-term services and supports programs, and demonstrations that pre-dated the FAI.
There is a limited but growing body of evidence examining the effects of these models on Medicare and Medicaid spending, health outcomes, and access to care. Broadly, studies to date have generally found a decrease in hospitalizations and readmissions for enrollees in the different models relative to those not enrolled in integrated models. Findings regarding the use of other services, such as use of the emergency department and long-term services and supports, were mixed—as are reports on beneficiary experience. It is often difficult to generalize from evaluations of specific models about the effects of integrated care more broadly.
This new inventory details a total of 51 studies, including those published between 2004 to November 2018 and formal evaluations on the FAI updated through July 2019, and gathers all available evidence on how programs have affected spending, quality, health outcomes, and access.
The State Health Access Data Assistance Center (SHADAC) is a program of the Robert Wood Johnson Foundation and a part of the Health Policy and Management Division of the School of Public Health at the University of Minnesota.