Financial Alignment Models for Medicare-Medicaid Enrollees: Considerations for Reimbursement
Article Publication Date
Summary
The 9 million individuals enrolled in both Medicare and Medicaid often receive care that is fragmented, poorly coordinated, and high-cost. Integrating their care is difficult because of the challenges associated with aligning the programs' financial incentives and reimbursement processes. This brief explores considerations for establishing reimbursement rates and performance incentives for the capitated and managed fee-for-service financial models.
Topics
Types/Tools
Populations
Sources
Center for Health Care Strategies, Inc., CHCS
Programs/Initiatives
States
Keywords
Financial Alignment Models; Capitated Model; Managed Fee-for-Service (FFS) Model; primary care case management (PCCM); administrative service organizations (ASOs); health homes; Centers for Medicare & Medicaid Services (CMS); Considerations for Reimbursement Arrangements and Performance Incentives; Integrated Rate Setting; Medicare Advantage and Special Needs Plans; PACE; Medicaid Managed Care Programs; Pay for Performance; Carved-Out Services; Supplemental Services
Contact
Center for Health
Care Strategies, Inc.
200 American Metro Blvd.
Suite 119
Hamilton, NJ 08619
NULL
Phone
609-528-8400