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Options to Integrate Health and Long-Term Care for Dual Eligibles
Date:3/10/2010

– PACE serves individuals who are age 55 and older, certified for nursing home care, able to live in the community, and residing within a PACE service area. By integrating Medicare and Medicaid funding streams, eligible beneficiaries receive all needed Medicare and Medicaid medical and supportive services in a fully coordinated fashion.
  • Shared Savings Model – The shared savings model allows physician groups, integrated health systems or regional coalitions to join together to create a tailored alternative payment system on a fee-for-service basis. The focus of this model is to align payment incentives and address cost shifting between Medicare and Medicaid.
  • State as Integrated Entity – This option would integrate Medicare and Medicaid benefits for dual eligibles at the state level. The Medicaid program would receive an agreed-upon amount of Medicare funding for participating dually eligible beneficiaries and would assume responsibility for the Medicare benefit.

  • "The current system of health and long-term care for dual eligibles is incredibly fragmented, forcing vulnerable seniors and adults with disabilities to fend for themselves in finding and obtaining appropriate, high quality care," said Bruce Chernof, MD, president and CEO of The SCAN Foundation. "Our vision is a society where seniors receive medical treatment and human services integrated in the setting most appropriate to their needs. This report is a first step toward realizing this vision for dual eligibles."


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    SOURCE The SCAN Foundation
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