State proposes Medicare-Medicaid integration, ACO partnerships

The healthcare system in New York is looking to optimize care and reduce costs by partnering with the Centers for Medicare & Medicaid Services (CMS) to integrate Medicaid and Medicare services and funding for dual-eligibles, according to recommendations from the New York State Department of Health.

Dual-integration will lead to improved patient outcomes through effective care management, the proposal notes. Because the nearly 700,000 individuals in New York who qualify for the Medicare and Medicaid programs have a high healthcare utilization rate, a unified entity that manages their care will ensure dual-eligibles receive the right care at the right time in the right setting, according to the state health department.

Under the proposal, the state would seek a waiver from CMS to partner with health plans or accountable care organizations under sub-capitation arrangements. Through those arrangements, patients would get access to better coordinated care, the federal government would save funds, and providers and health plans would enjoy simplified administration, as well as the ability to share in savings.

But in order for the initiative to succeed, the state and CMS need to financially and systematically integrate Medicaid and Medicare while still giving patients the freedom of choice, according to the proposal.

To learn more:
- here's the recommendations (.pdf)

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