Evaluations of Integrated Care Models for Dually Eligible Beneficiaries: Key Findings and Research Gaps

August 2020

While many dually eligible individuals experience fragmented care across their Medicare and Medicaid benefits, integrated care models are designed to align service delivery, payment, and administration across both programs. The ultimate goals of these models are to improve care and reduce spending. This report evaluates the growing body of evidence of three integrated care models: (1) Medicare Advantage dual eligible special needs plans; (2) Medicare-Medicaid plans that operate under the Financial Alignment Initiative; and (3) the Program of All-Inclusive Care for the Elderly, to understand how each of these models affects Medicare and Medicaid spending, health outcomes, and access to care.

Overall, studies of these models reported lower hospitalizations and readmissions for enrollees in integrated models. However, studies reported mixed results related to the use of long-term services and supports, beneficiary experience, and spending. This report can support policymakers that want to understand the landscape of evidence across integrated care models, including evaluations of state and regional programs. Future research that examines the impact of these models for specific subpopulations of dually eligible individuals and on Medicaid costs may further support policy efforts to design effective integrated care models.

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