Assessment of the literature on integrated care models for people dually enrolled in Medicare and Medicaid: approaches used and priorities for future research
- Collection:
- Health Policy and Services Research
- Author(s):
- Barrie Smith, Laura, author Waidmann, Timothy A., author Caswell, Kyle J., author
- Contributor(s):
- Urban Institute, issuing body.
- Publication:
- Washington, DC : Urban Institute, September 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Dual MEDICAID MEDICARE Eligibility Medicare Part C -- organization & administration Outcome Assessment, Health Care -- statistics & numerical data Treatment Failure United States Centers for Medicare & Medicaid Services (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- People dually enrolled in Medicare and Medicaid have, on average, more complex medical, long-term care, and social needs relative to people enrolled in only one of the programs. Because Medicare and Medicaid providers generally address different needs and lack incentives to coordinate with each other, dual enrollees risk missing needed services; receiving duplicative care; experiencing avoidable emergency department visits, hospitalizations, and readmissions; and exhibiting poor health outcomes. To reduce these risks, the Centers for Medicare & Medicaid Services (CMS), managed-care organizations, providers, and other stakeholders have developed various Medicare and Medicaid integrated care models. These models include the Program of All-Inclusive Care for the Elderly (PACE), Financial Alignment Initiative (FAI) models, Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), and Fully Integrated Dual Eligible Special Needs Plans. Understanding the effects of integrated care plans on health outcomes, utilization, and spending remains an ongoing priority to improve care for dually enrolled people. CMS has funded formal evaluations of state FAI models, and other researchers have pursued various evaluative studies on other integrated care plans. In August 2020, the Medicaid and CHIP Payment and Access Commission (MACPAC) conducted a systematic literature review and created an inventory of 57 existing evaluations of integrated care models published between 2004 and July 2020. Their literature review indicated that most studies on integrated care plans found the plans decrease hospitalizations and readmissions. However, findings related to other service types and outcomes are mixed and difficult to generalize across plan types, warranting continued research in this area. What We Did. The purposes of this review are to critically assess the evaluative literature on integrated models for dual enrollees and to identify opportunities for researchers to consider. In particular, we examine the empirical and methodological approaches that have been used to evaluate integrated plans and highlight where gaps remain in the approaches taken. We reviewed each of the studies in the MACPAC inventory, focusing on the empirical methods used and the strengths and limitations of each approach. What We Found. In the subsequent sections, we describe the findings from our review. First, we summarize the types of data sources and study designs commonly used. Then, we discuss the extent to which studies have incorporated a conceptual framework into their approaches and assess external validity. Though not the primary purpose of this review, we briefly summarize key findings from existing evaluations to help orient researchers seeking to contribute to the literature.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (19 pages))
- NLM Unique ID:
- 9918300289006676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918300289006676