Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries—Health Plan Standards, Challenges and Evolving Approaches

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March 2019 | Dually Eligible Beneficiaries

MACPAC contracted with Health Management Associates (HMA) to examine care coordination requirements for several types of integrated care models:

  • managed long-term services and supports programs that require integration with Medicare Advantage dual eligible special needs plans,
  • fully integrated dual eligible special needs plans, and
  • the Financial Alignment Initiative.

This report summarizes the results of HMA’s work, which included reviewing contracts and conducting stakeholder interviews. HMA found that while a few states have prescriptive contract standards regarding care coordination, most states provide plans with a great deal of flexibility. States and plans noted advantages and disadvantages to both approaches. Stakeholders indicated that engaging primary care providers in care coordination can be difficult and that there are opportunities for plans to more effectively partner with consumer advocates and providers of home and community-based services (HCBS) improve care coordination.

Publication Type: Contractor Reports

Tags: adults over age 65, case management, dually eligible beneficiaries, duals demonstrations, managed care, people with disabilities