Dual eligible beneficiaries are an important subset of the Medicare and Medicaid populations because they have a high prevalence of chronic conditions and disabilities, substantial care needs, and high health care and long-term services and supports (LTSS) utilization and costs. Integrated care models have the potential to coordinate the administration, financing, and delivery of primary, acute, and behavioral health care, as well as LTSS across the Medicare and Medicaid programs, providing significant opportunities to improve care delivery and experience of care for dual eligible beneficiaries. Examples of integrated care models include the Program of All-Inclusive Care for the Elderly (PACE), Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), and D-SNPs, which have varying degrees of benefit integration and administrative alignment. For policymakers, the ability to compare the quality of care and outcomes across the different models and determine their effectiveness is hindered by the lack of timely and accurate utilization data submitted by the managed care plans, referred to as encounter data. In this study, we used Medicare encounter data from 2015 to analyze and compare selected measures of service utilization and outcomes for dual eligible beneficiaries enrolled in three types of integrated care models--D-SNPs, FIDE-SNPs, or PACE--relative to their counterparts enrolled in regular, non-integrated MA plans.
The report was prepared under contract #HHSP233201600021I between HHS/ASPE Office of Behavioral Health, Disability and Aging Policy and the Research Triangle Institute. For additional information about this subject, you can visit the BHDAP home page at https://aspe.hhs.gov/about/offices/bhdap or contact the ASPE Project Officer, at HHS/ASPE/BHDAP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201; Jhamirah.Howard@hhs.gov.
- Comparing Outcomes for Dual Eligible Beneficiaries in Integrated Care: Final Report (September 2021)