UNDERSTANDING CARE COORDINATION EXPERIENCES IN A STATE MEDICARE-MEDICAID FINANCIAL ALIGNMENT DEMONSTRATION

• Published in: Journal of health and human services administration Vol. 41; no. 2; pp. 196 - 236
• Main Authors: CRAVER, GERALD A., GIMM, GILBERT, HILL, KATHERINE E. VATALARO
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SPAEF 01.06.2018; SAGE Publications
• Subjects: Managed Care Long Term Services and Supports; Care Coordination; Qualitative Evaluation; Dual Eligible Beneficiaries; Medicare-Medicaid Financial Alignment Demonstration
• ISSN: 1079-3739; 2168-5509
• DOI: 10.1177/107937391804100203

Known as dual eligible beneficiaries, individuals receiving Medicare and Medicaid benefits often have complex needs and account for a disproportionate share of healthcare spending. In 2014, Virginia implemented Commonwealth Coordinated Care, a managed care financial alignment demonstration authorized under the Affordable Care Act, to improve care for these individuals. Given the complexity of their needs, examining how dual eligible beneficiaries along with their care coordinators and providers experienced the demonstration is important. By analyzing qualitative data collected as part of a larger mixed-methods evaluation, several themes were identified illustrating individuals' experiences. The study findings suggest that how individuals interacted and formed relationships influenced how beneficiaries' health and social needs were met during the program. By providing insight into individuals' experiences in a managed care program that integrated medical and long term services and supports for Medicare-Medicaid beneficiaries, the study can inform the development of future initiatives for similar populations.