As the landscape of integrated care models continues to evolve, it begs the question—do these integrated care models deliver better outcomes compared to non-integrated MA plans?
Research Assessing The Effects Of Integrated Care Models Is Limited
Based on a review of studies published between 2004 and 2020, the Medicaid and CHIP Payment and Access Commission (MACPAC) reported mixed findings regarding the effectiveness of integrated care models. Study findings generally aligned for certain outcomes (for example, fewer hospitalizations and readmissions for dually eligible beneficiaries in integrated care models, compared to those in non-integrated models) but were mixed for others (for example, emergency department use, LTSS use, and beneficiary experience). In general, studies lacked generalizability because they only focused on one type of integrated care model, included limited geographies and populations, and were limited to specific time frames. Due to these limitations, it is hard to determine the effectiveness of both individual integrated care models and integrated care broadly because models can vary significantly in their specific care delivery approaches, geographic distribution, frailty of the population they serve, and the extent of service integration. PACE, for example, includes an interdisciplinary team and site-based services at an adult day center. In contrast, most D-SNPs do not include single care teams, and beneficiaries receive care at the site of their community providers, as they would in a typical managed care plan.
Until recently, research comparing outcomes for dually eligible individuals in integrated care models has been hindered by the lack of timely, accurate service utilization data submitted by the managed care plans, known as encounter data. But in 2019, CMS released MA encounter data for 2015, the first year such data were deemed sufficiently complete and useable for research purposes. Using these data, RTI International and the Office for the Assistant Secretary for Planning and Evaluation conducted exploratory analyses to determine the feasibility of evaluating outcomes across multiple types of integrated care models nationally—the first endeavor of its kind, to our knowledge.
Integrated Care Models Are Associated With Favorable Outcomes For Dually Eligible Individuals
We compared five service utilization and outcome measures (any inpatient hospitalization, any emergency department [ED] visit, any institutional LTSS use, any home and community-based services [HCBS] use, and mortality) among dually eligible individuals enrolled in three types of integrated care models—D-SNPs, FIDE-SNPs, and PACE—each relative to dually eligible individuals enrolled in regular, non-integrated MA plans. For each measure, we conducted a multivariate regression analysis that controlled for beneficiary demographic characteristics, comorbidities (as measured by nearly 80 Hierarchical Condition Categories [HCCs]), and an indicator for each state to account for variations in state policies and other state-specific factors that were not measured but could influence the outcome. Our analysis excluded beneficiaries enrolled in MMPs because they are being evaluated as part of the FAI demonstrations.
After adjusting for beneficiary demographics and comorbidities, we found promising evidence that dually eligible individuals enrolled in these integrated care models had, in general, a more favorable pattern of service use and mortality than those in regular, non-integrated MA plans. Compared to dually eligible individuals in regular MA plans, our findings indicate that those in D-SNPs and PACE had lower odds of hospitalization, while beneficiaries in FIDE-SNPs had higher odds of hospitalization (see exhibit 2 for a visual summary). Dually eligible beneficiaries in D-SNPs and FIDE-SNPs were more likely to visit the ED than those in regular MA, while those in PACE were less likely to do so. Furthermore, dually eligible individuals in D-SNPs, FIDE-SNPs, and PACE were less likely to use institutional LTSS, and those in D-SNPs and FIDE-SNPs were more likely to use HCBS, than those in regular MA. Additionally, we found that dually eligible individuals in D-SNPs and FIDE-SNPs had significantly lower mortality risk than those in regular MA plans, while the mortality risk of those in PACE did not differ significantly compared to those in regular MA plans, despite higher average frailty levels.
Exhibit 2: Multivariate regression associations between integrated care plan enrollment and service use and mortality among dually eligible beneficiaries in 2015, compared to enrollment in a regular MA plan