Comparing outcomes for dual eligible beneficiaries in integrated care: final report
- Collection:
- Health Policy and Services Research
- Author(s):
- Feng, Zhanlian, author Wang, Joyce, (Of RTI International), author Gadaska, Angela, author Knowles, Molly, author Haber, Susan G., author Ingber, Melvin, author Grouverman, Valentina, author
- Contributor(s):
- United States. Department of Health and Human Services. Office of Behavioral Health, Disability, and Aging Policy, issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Behavioral Health, Disability, and Aging Policy, September 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated Dual MEDICAID MEDICARE Eligibility Managed Care Programs Medicare Part C Outcome Assessment, Health Care United States
- Genre(s):
- Technical Report
- Abstract:
- Dual eligible beneficiaries are an important subset of the Medicare and Medicaid populations because they have a high prevalence of chronic conditions and disabilities, substantial care needs, and high health care and long-term services and supports (LTSS) utilization and costs. The enrollment of dual eligible beneficiaries in managed care has grown significantly with the introduction of Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs) that specifically target this population and of state-developed Medicaid managed long-term services and supports (MLTSS) plans or comprehensive Medicaid managed care plans that include LTSS. Integrated care models have the potential to coordinate the administration, financing, and delivery of primary, acute, and behavioral health care, as well as LTSS across the Medicare and Medicaid programs, providing significant opportunities to improve care delivery and experience of care for dual eligible beneficiaries. Examples of integrated care models include the Program of All-Inclusive Care for the Elderly (PACE), Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), and D-SNPs, which have varying degrees of benefit integration and administrative alignment. For policymakers, the ability to compare the quality of care and outcomes across the different models and determine their effectiveness is hindered by the lack of timely and accurate utilization data submitted by the managed care plans, referred to as encounter data. In 2019, the Centers for Medicare & Medicaid Services released the MA encounter data for 2015, the first year for which the nationwide Medicare encounter data on service use were considered to be reasonably complete and useable for research purposes. In this study, we used Medicare encounter data from 2015 to analyze and compare selected measures of service utilization and outcomes for dual eligible beneficiaries enrolled in three types of integrated care models--D-SNPs, FIDE-SNPs, or PACE--relative to their counterparts enrolled in regular, non-integrated MA plans. Our analysis did not include beneficiaries in plans under the Financial Alignment Initiative demonstrations; their service use and outcomes are being evaluated separately and are beyond the scope of this study.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (v, 25, R-4, A-5 ,B9, C-20 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918574283706676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918574283706676