What is a Collection?
Playbook Collections explore interventions that address the needs of people with complex needs by curating available peer-reviewed research, case studies, and tools. Although not exhaustive, Collections evolve as new and promising research and other resources are available.
Across the United States, approximately 13 million people are dually eligible for both Medicare and Medicaid, but only a small portion are covered by programs that coordinate care and services across Medicare and Medicaid benefits — also known as integrated care models. Integrated care models include the Program of All-Inclusive Care for the Elderly (PACE), Medicare Advantage dual eligible special needs plans (D-SNPs), and Medicare-Medicaid plans authorized through the federal Financial Alignment Initiative, which ends December 31, 2025. Two types of D-SNP, fully integrated dually eligible special needs plans (FIDE SNPs) and highly integrated dually eligible special needs plans (HIDE SNPs) provide greater integration between Medicare and Medicaid benefits than other D-SNPs. States that participated in the Financial Alignment Initiative will transition enrollees to either FIDE SNPs or HIDE SNPs.
While the policy landscape and coverage options for dually eligible individuals have shifted over time, evidence on these models can inform future design and implementation of integrated care programs for this population.
States, health plans, health systems, and policymakers interested in more effectively addressing the complex needs of dually eligible individuals can use this Better Care Playbook Collection to understand the evidence on Medicare-Medicaid integration and learn about promising strategies for implementing integrated care models. The Collection includes evidence-based strategies that promote models of care that integrate both services and financing for dually eligible individuals.
What works in Medicare-Medicaid integration?
Following are summaries of peer-reviewed research, evaluations, and reports on recent integrated care approaches. Many of these programs have demonstrated positive results, such as improving individuals’ experience of care, increasing care quality, and reducing avoidable costs.
What do these models look like in practice?
Below find on-the-ground perspectives and experiences on implementing integrated care models for dually eligible beneficiaries. Case studies offer details that can be useful for stakeholders interested in implementing these or similar models.
What tools exist to support developing or improving integrated care programs?
Following are practical tools and strategies that health plans, policymakers, health system leaders, and other interested stakeholders can use to create or improve integrated care programs.