Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans under the Financial Alignment Initiative

MedicalResearch.com Interview with:
Angela Greene

Deputy director of Aging, Disability and Long Term Care Program
RTI International

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services created the Financial Alignment Initiative to test integrated care models for Medicare -Medicaid enrollees (dual-eligible beneficiaries). CMS contracted with RTI International to monitor the implementation of these demonstrations and to evaluate their impact on beneficiary experience, access, quality, utilization, and cost.

Care coordination is a key component of all demonstrations under this Initiative. Specifically, CMS and participating States believe that care coordination will improve quality and cost outcomes by increasing preventive and timely care, reducing avoidable hospitalizations, improving the beneficiary experience, and delaying institutionalization.
Our report provides an update on the status of care coordination activities and early findings on successes and challenges of providing care coordination services for the nine capitated model demonstrations implemented between October 2013 and February 2015.

Our early findings around care coordination suggest that although states are implementing demonstrations that differ in some ways, participating plans in each state are implementing new care coordination approaches designed to integrate care across medical, long term services and supports, and behavioral health systems and that they have overcome several challenges in doing so. Once dual-eligible beneficiaries become familiar with their care coordinators and develop relationships with them, they find them to be useful in coordinating care and improving access to services.

MedicalResearch.com: What should readers take away from your report?

Response: In addition to the findings mentioned earlier, our study shows care coordinators are providing a new service that dual-eligible beneficiaries generally feel is beneficial. CMS, States, and participating plans are all invested in this process and are working to make it succeed despite several challenges.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: A major goal of the evaluation is to monitor how care coordination is affecting the beneficiary experience, access to needed services, quality of care and cost. Our team will continue to track beneficiary experience with care coordination in several ways, including through focus groups and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We will also be using Medicare and Medicaid claims and encounter data to assess the effect on utilization, quality and cost.

This research was funded by the Centers for Medicare & Medicaid Services.
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Citation:
Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans under the Financial Alignment Initiative

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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