Field of Work: Helping states integrate—or move toward integration of—acute care and long-term care for dual eliglbles (low-income elders and people who are disabled who are eligible for both Medicare and Medicaid) who are enrolled in Medicare and Medicaid managed care.
Problem Synopsis: The U.S. health care system has caused dual eligibles many problems in getting adequate care. Acute care (covered by Medicare) and long-term care (covered by Medicaid) are rarely integrated, leading not only to poor patient care but to serious clinical, financial and administrative inefficiencies. The growth of managed care in the 1990s seemed to present an opportunity—and organizational vehicle—to provide integrated acute and long-term care to dual eligibles.
Synopsis of the Work: The Medicare/Medicaid Integration Program (MMIP) (1997 to 2006) was a state demonstration program that tested the operation and design of delivery systems that integrate long-term and acute care services under combined Medicare and Medicaid capitation payments for elderly patients.
- Three approaches for managing the care of dual eligibles emerged during the Medicare/Medicaid Integration Program: full integration, partial integration and managed fee-for-service.
- Massachusetts, Minnesota and Wisconsin launched or refined projects fully integrating Medicare and Medicaid financing and services for patients.
- Florida and Texas launched coordination efforts in which staff at managed care organizations coordinated Medicare/Medicaid acute and long-term patient care.
- Maine and Vermont experimented with managed fee-for-service projects with patient care coordinated by primary physicians' staff or state case managers working at their offices.
- Staff of the Medicare/Medicaid Integration Program helped states integrate their Medicare and Medicaid data, through advisory meetings with state project staffs, the use of consultants, a data users group and two technical assistance reports on data collection, use and integration.
- The program also helped build support for Medicare/Medicaid integration among staff at the federal Centers for Medicare & Medicaid Services (CMS) and in state governments, according to the National Program Director RWJF Program Officer.
Key Evaluation Findings: MMIP's evaluators reported the following findings:
- A CMS-sponsored evaluation of 1998–2001 data from two projects—Minnesota Senior Health Options and the Wisconsin Partnership Program—indicated mixed enrollee outcomes at both initiatives.
- A subsequent analysis of the Wisconsin project showed improved outcomes, including:
- The project's disabled enrollees spent fewer days as hospital inpatients than individuals in comparable groups outside the project.
- Its elder enrollees spent fewer days in nursing homes than individuals in comparable groups.
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