Medicare-Medicaid Integrated Care Programs

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, more than 12 million people are dually eligible for both Medicaid and Medicare, but only about one million receive coordinated services. People who are dually eligible for Medicare and Medicaid are often left to navigate a fragmented and uncoordinated system of care on their own. Fully integrated care programs — such as fully integrated dual eligible special needs plans (FIDE SNPs), Programs of All-Inclusive Care for the Elderly (PACE), and other Medicare-Medicaid plans — coordinate services across Medicare and Medicaid and are designed to help dually eligible individuals maneuver this confusing landscape.

Health plans, policymakers, and health system leaders 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 fully integrated care programs and delivery models. The collection includes evidence-based strategies that promote models of care that integrate services and financingSee also general resources on Medicare-Medicaid integration.

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.