CMS debuted three payment models for treating the roughly 12 million Americans who are dually eligible for Medicare and Medicaid.
The models, which CMS presented in an April 24 letter to State Medicaid Directors, aim to test approaches to better serve dually eligible Americans, who often have multiple chronic conditions and socioeconomic risk factors that can negatively affect health outcomes.
Each year, CMS spends more than $300 billion on care for dually eligible individuals, but the agency said it's not translating to an improvement in health outcomes.
"Less than 10 percent of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems. This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all," CMS Administrator Seema Verma said in a press statement.
CMS discussed three models for states to consider:
1. Capitated Financial Alignment Model: Under this model, states and health plans would enter a joint contract with CMS to provide Medicare and Medicaid services for a capitated amount.
2. Managed Fee-for-Service Model: Under this model, states and CMS would partner to allow states to share in Medicare savings where services are covered on a fee-for-service basis.
3. State-Specific Models: Under this model, CMS would consider partnering with states to test new models that the state develops. States would propose the ideas to CMS through concept papers and proposals.
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