MEDICARE AND MEDICAID INTEGRATION IN THE UNITED STATES: CHALLENGES AND SOLUTIONS

摘要

Over 10 million seniors and adults with significant disabilities in the United States (US) are dually eligible for Medicaid and Medicare. They represent beneficiaries with the lowest incomes and, on average, the most complex care needs and the highest care utilization. For this reason, they account for a disproportionate share of spending in both programs. In Medicare FFS spending is more than twice as high for dual eligible beneficiaries compared with non-dual eligible beneficiaries. The frequently misaligned incentives in Medicare and Medicaid can cause much inefficiency, including duplication of care, poor coordination of care, and higher rates of avoidable hospitalizations. In an effort to both integrate care and reduce costs, the Patient Protection and Affordable Care Act gave the Centers for Medicare and Medicaid Services (CMS) new authority to implement and test programs to align financing and administration of Medicaid and Medicare for dually eligible beneficiaries. In this symposium, researchers and policy experts will come together to discuss the issues around Medicare and Medicaid integration in the US as well as several models currently being tested. Experts from the Center for Health Care Strategies will give an overview on the challenges faced in integrating these two large programs and the various efforts being taken in the US. Researchers from University of California will present results from the evaluation of California’s Dual Financial Alignment demonstration, in particular the innovation on the part of the health plans in implementing the program, and the perspectives of beneficiaires who participated in the program. Researchers from the Washington State Health Care Authority will present results from an evaluation of their health-home based, managed fee for service program in Washington state as well as insights from the state’s experience working with beneficiaries and providers to transform care for this high-cost, high-need population.