CMS reports better outcomes for dual eligibles through integrated care pilot
For decades policymakers have hypothesized that better integration of Medicare and Medicaid services could help improve health outcomes for people enrolled in both programs. Since the passage of the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) has focused on promoting integrated care and developing new payment and service delivery models for dually eligible beneficiaries. Now the evidence is stronger than ever: integrated care is improving outcomes.
Today, the Department of Health and Human Services (HHS) published a report about the Minnesota Senior Health Options (MSHO) program. CMS and the State of Minnesota started MSHO as a pilot in 1997 to better serve dually eligible beneficiaries age 65 and older. MSHO plans coordinate all the Medicare and Medicaid benefits their members receive, including Medicare coverage of acute medical care and Medicaid coverage of long-term services and supports. Over the years, MSHO has been a platform for delivery system reform within Minnesota.
The new report gives us the clearest view yet into MSHO’s effectiveness. The HHS Assistant Secretary for Planning and Evaluation contracted with RTI International to evaluate MSHO’s outcomes from 2010 to 2012. RTI compared the experiences of similar beneficiaries inside and outside of MSHO and found that MSHO enrollees were:
• 48 percent less likely to have a hospital stay, and those who were hospitalized had 26 percent fewer stays;
• 6 percent less likely to have an outpatient emergency department visit, and those who did visit an emergency department had 38 percent fewer visits; and
• 13 percent more likely to receive home and community-based long term care services.
In 2013, CMS made investments to further strengthen the existing MSHO program through increased alignment of Medicare and Medicaid program administration, federal-state data sharing, and beneficiary materials. CMS is also partnering with 12 other states to implement and evaluate new models of integrated care similar to MSHO through the Financial Alignment Initiative. From 2011 to 2015, the number of dually eligible beneficiaries served in integrated care programs across the country rose from approximately 162,000 to more than 650,000.
Integrated care is improving the lives of some of the most vulnerable Americans. These new findings from Minnesota affirm the promise of integrated care and reinforce the urgency with which we need to continue to develop, test, and scale successful models for better serving dually eligible individuals.
Read the complete report.