The U.S. Department of Health and Human Services released plans for new initiatives aimed at providing better quality care for the nine million Americans enrolled in both Medicare and Medicaid as well as lowering costs for federal and state governments.
The Centers for Medicare and Medicaid (CMS) will be launching a pilot program in the coming months testing two new models of care integration and is currently looking for states to participate in the test program. The two models each seek to better integrate primary, acute, behavioral health, and long term care services in different ways. The Capitated Model utilizes a three-way contract between the state, CMS, and high-performing health plans. The health plans would receive a blended capitated rate for the full array of benefits provided to Medicare-Medicaid enrollees. CMS hopes this contract will simplify the program and allow more flexible benefits. The other plan, the FSS Model, also known as the Managed Fee-for-Service Model, would implement retrospective performance payments based on Medicare savings achieved for Medicaid- Medicaid enrollees. In this arrangement, the state would be responsible for ensuring integration of benefits.
CMS has also announced a new technical resource center to assist states in providing care for dual eligibles. These tools will facilitate the sharing of best practices among states, provide technical assistance in areas such as stakeholder engagement and program design, as well as conduct needs assessment and gap analysis to help states identify places for improvement. Specialized resources will also be available for the states participating in the pilot programs.
The final initiative CMS described was a new demonstration focused on reducing preventable hospitalizations among nursing home residents. CMS will select independent organizations this fall to partner with nursing facilities to implement practices that prevent falls, pressure ulcers, and other problems that lead to these preventable hospitalizations.
Read the press release from CMS or learn more about the specific financial models and technical resources.
