Background
In Pennsylvania, members eligible for both Medicare and Medicaid have the option of receiving each from the same insurance provider, with their Medicaid coverage coming from the state’s Community HealthChoices (CHC) program. This “alignment” in coverage is thought to promote care management for members since insurance providers have access to more complete patient information, especially for those receiving long-term services and support from their CHC coverage.
Healthcare Challenge
Dual-eligible members have separate coverage from Medicare and Medicaid, and typically have higher health care utilization than the rest of the population. This makes coordinating their coverage particularly important for improving members’ clinical outcomes and cost containment and experience.
Goals
The goal of this project was to evaluate the impact of alignment on members’ clinical outcomes, expenditures, and experience.
Implementation Approach and Findings
Population
UPMC dual-eligible members from 2018 through 2022.
Methodology
This study used both quantitative and qualitative methodologies.
Impacts of alignment on members’ clinical outcomes and expenditures were explored using regression analysis.
Impacts of alignment on members’ experiences were explored using a combination of qualitative approaches including descriptive synthesis of relevant published literature, internal data and reports, and key informant discussions.