Integrating Care for Dual Eligible Enrollees: Improving Quality and Coordination

1. Integrating Care for Medicare- Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 2011

2. Who are Medicare-Medicaid Enrollees? 9.2 million individuals (2008) that are enrolled in both Medicare and Medicaid (or dual eligibles). More likely to have mental illness, have limitations in activities of daily living and multiple chronic conditions. Few are served by coordinated care models and even fewer are in integrated models that align Medicare and Medicaid. 2 1 Based on 2006 data.

3. Medicare-Medicaid Beneficiaries Account for Disproportionate Shares of Spending Total Medicare Population, 2006: 43 Million Total Medicare FFS Spending, 2006: $299 Billion Total Medicaid Population, 2007: 58 Million Total Medicaid Spending, 2007:$311 Billion Dual Eligibles as a Share of the Medicare Population and Medicare FFS Spending, 2006: Dual Eligibles as a Share of the Medicaid Population and Medicaid Spending, 2007: Kaiser Family Foundation, The Role of Medicare for the People Dually Eligible for Medicare and Medicaid, January 2011. http://www.kff.org/medicare/upload/8138.pdf

4. Medicare-Medicaid Coordination Office Section 2602 of the Affordable Care Act (ACA) Purpose: Improve quality, reduce costs, and improve the beneficiary experience. Ensure dually eligible individuals have full access to the services to which they are entitled. Improve the coordination between the federal government and states. Develop innovative care coordination and integration models. Eliminate financial misalignments that lead to poor quality and cost shifting. 4

5. Focus on Beneficiary and Person Centered Care and Service Delivery Improve dual eligibles satisfaction, program awareness, health, functional status, and well-being. Assure dual eligibles are receiving high quality, person centered acute, behavioral, and long term services and supports. 5

6. Medicare-Medicaid Coordination Office Major Areas of Work The Medicare-Medicaid Coordination Office is working on a variety of initiatives to improve access, coordination and cost of care for Medicare-Medicaid enrollees in the following areas: Program Alignment Data and Analytics Models and Demonstrations Other 6

7. One Example: Financial Alignment Demonstrations to Support State Efforts to Integrate Care Capitated Model: Three-way contract among State, CMS and health plan to provide comprehensive, coordinated care in a more cost-effective way. Managed FFS Model: Agreement between State and CMS under which States would be eligible to benefit from savings resulting from initiatives to reduce costs in both Medicaid and Medicare. 37 States and the District of Columbia submitted letters of intent to participate in these financial demonstrations. CMS will work with these States to further develop these approaches. States must meet established standards and conditions, including implementation by 2012. 7

8. New Models Expand and Promote State Partnerships Financial Alignment Initiative 8 DC Financial Alignment Model Letters of Intent- State Map KEY: Submitted Letter of Intent

9. Questions & Suggestions: MedicareMedicaidCoordination@cms.hhs.gov http://www.cms.gov/medicare-medicaid-coordination/ For more information, visit: