In a recent New England Journal of Medicine perspective titled "Improving Care Integration for Dually Eligible Beneficiaries," Harvard Professor of Health Care Policy, David Grabowski, PhD, discusses the current approaches to care integration for dual beneficiaries in response to a bipartisan call for feedback by the Senate to improve care for dual enrollees.

Dual enrollees are beneficiaries enrolled in both Medicare and Medicaid. This population is more likely to have multiple chronic conditions, require long term care, or have a serious mental illness. Because of their various needs, more Medicare and Medicaid funding must be allocated for their care, but because the two programs are not aligned, these beneficiaries face variable care and poor health outcomes when it comes to services across the two programs. In the article, Grabowski suggests a series of steps that policymakers could take to encourage better integrated care for dually eligible beneficiaries.

Three approaches are currently in place to encourage care integration for dual beneficiaries.: state Medicare–Medicaid plans (MMPs), the federal Program of All-Inclusive Care for the Elderly (PACE), and federal dual-eligible special-needs plans (D-SNPs). Unfortunately, most duals do not currently have access to these models. Grabowski follows with a series of suggestions for broadening the availability of highly integrated plans.

The first suggestion involves increasing the use of passive enrollment; rather than allowing Medicare beneficiaries to choose their coverage and potentially miss integrated plans, it is suggested that integrated plans become the default, requiring dual eligibles to “opt-out” of this model, if desired.

The second suggestion calls for integrated care models which rely on a single company to improve program financial alignment. This effort would encourage more efficient use of resources and help to encourage stronger integration of care.

Third, he suggests standard D-SNPs could be converted to FIDE-SNPs. Because many D-SNPs do not currently integrate Medicaid benefits, it is suggested Congress could make such integration a requirement and eliminate “Medicare-only” D-SNPs; working with states to transition D-SNPs to FIDE-SNPs.

Fourth, Grabowski suggests that improved data and measures be developed, which would result in more meaningful evaluation of care received by dual eligibles.

Finally, movement toward a unified approach to integrated care is encouraged; enrolling more dually eligible beneficiaries into integrated care models will require an active effort by policymakers to make it a reality.