Integrating Care for Medicare-Medicaid Enrollees Using a Managed Fee-for-Service Model

Integrating care for Medicare-Medicaid enrollees through managed fee-for-service (FFS) models offers a new opportunity for states to improve service delivery and benefit from savings that can result from improved quality and more effective service use in both Medicare and Medicaid. Well-designed managed FFS programs will have a clear vision of integration implemented through an accountable entity capable of bringing together the fragmented pieces of the FFS system, and making significant upfront investments in management, staff, and information systems. Other key program design elements include: (1) identification of high-need, high-cost beneficiaries; (2) use of a multidisciplinary care team; (3) comprehensive assessment of beneficiaries; (4) development of a person-centered care plan; (5) implementation of comprehensive care management interventions; (6) real-time information exchange; and (7) financial alignment.