Evaluation of the Medicare and Medicaid Financial Alignment Initiative

Evaluating efforts to integrate health and long-term care financing for beneficiaries eligible for both Medicare and Medicaid

The Centers for Medicare & Medicaid Services (CMS) has been working with state Medicaid programs and private-sector health plans to integrate the financing and delivery mechanisms used to cover beneficiaries eligible for both Medicare and Medicaid (dually eligible).

RTI is conducting an in-depth evaluation of these state-level demonstrations to integrate financing and care for dually eligible beneficiaries. The evaluation focuses on monitoring and measuring the success of these demonstrations to improve quality, access, and the beneficiary experience, as well as the demonstration’s impact on costs of care.

RTI brings a diverse array of clinical and methodological expertise to this evaluation, including experts in the fields of health policy, health economics, gerontology, long-term services and supports, and quantitative and qualitative methods. This highly experienced team developed a complex analytic design which included a sophisticated approach to comparison group selection in our analyses of cost-savings and service utilization. RTI also conducted extensive site visits, key informant interviews, and beneficiary focus groups to better understand the impacts of the various demonstrations.

More than 400,000 beneficiaries are enrolled in these demonstrations across 11 states. Some demonstrations are significantly reducing cost drivers such as hospitalization rates and improving the beneficiary experience through intensive care coordination, use of flexible benefits to address social determinants of health, and innovative service delivery approaches. Our findings have also suggested that managed care plans have the opportunity to better address long standing problems, such as reliable medical transportation, by using their purchasing power.

The demonstrations under the Financial Alignment Initiative are scheduled to continue for several more years, and RTI and its partners will continue to monitor and report on the impact of the demonstrations.