Integrated Delivery System for Dual Eligibles

October 10, 2016

EBG Advisors has explored the Maryland health care landscape to help the state's Medicaid agency understand the opportunities and challenges of different pathways to coordinating care of individuals dually eligible for Medicare and Medicaid. Efforts included examining other states’ approaches and, in particular, considering a unique approach relying upon accountable care organizations (ACOs). EBG Advisors also facilitated the deliberations of a workgroup comprised of 25 representatives of consumers, providers, health plans and other stakeholders. We have guided the agency on choosing its strategy, produced content for the workgroup’s consideration, educated the workgroup members, and led the group’s monthly in-person meetings. EBG Advisors has also joined substantively in the agency’s meetings with the CMS Innovation Center to discuss the options and federal approval requirements.

Solution         

To date, the project has yielded a conclusion on a hybrid model for duals (ACOs in areas of high population density, managed fee-for-service elsewhere) and tentative agreement with CMS on a waiver pathway toward implementing the model.