The model matters. That was the take away of a new study—Health Outcomes Of Dually Eligible Beneficiaries Under Different Medicare Payment Arrangements—that compared consumer outcomes in three types of plans serving dual eligible consumers: at-risk Medicare Advantage (MA), fee-for-service Medicare Advantage, and traditional Medicare. The analysis found that integration of the service delivery model and financial incentives resulted in better consumer outcomes.

The analysis looked at 20 measures of outcomes. These included utilization measures like inpatient admissions, readmissions, avoidable emergency department (ED) use in total and for chronic diseases.;The measures also included medication . . .

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Integrated Care Models

Integrated care models have become a basic premise for service delivery in the health and human service field. Stemming from the focus on comprehensive whole-person health, integrated care models include the complete array of services for a person’s health and well-being—physical health, behavioural health, pharmacy benefits, and social supports. For health and human service provider organizations, there are many possibilities to serve consumers by taking a whole person approach to health care. From care coordination initiatives and addressing the social determinants of health to integrating primary and behavioural health care, payers and health plans are looking for a holistic approach when it comes to managing complex consumer populations.


The New Jersey Department of Health (NJDOH) plans to create a single, integrated license for outpatient health care facilities that will allow the license holders to deliver integrated primary care, mental health, and addiction treatment services, as described in a new proposed rule. NJDOH anticipates that the integrated license will enable delivery of comprehensive, whole-person care, leading to improved health outcomes and a better consumer experience. Currently, provider organizations seeking to provide integrated care, primary… Read