Enrollment in Medicare/Medicaid integrated care programs is growing—but not by enough, says expert

June 12, 2023—Enrollment in integrated care programs (ICPs), which coordinate health care services for people enrolled in both Medicare and Medicaid, has grown in recent years—but that growth has been small, especially compared to conventional plans, according to a new study led by Harvard T.H. Chan School of Public Health.

The study was published in the May 2023 edition of Health Affairs. Co-authors included Jose Figueroa, assistant professor in the Department of Health Policy and Management, and John Orav, associate professor in the Department of Biostatistics.

ICPs aim to improve the patient experience for “dual-eligibles”—those who qualify for coverage under both Medicare and Medicaid. But enrollment trends in ICPs have gone largely unexamined. To fill in this gap, the researchers used national data to evaluate enrollment changes in ICPs between 2013 and 2020. The study found that the proportion of dual-eligibles enrolled in an ICP increased from 2% in 2013 to 9.4% in 2020—but that the number of dual-eligibles enrolled in non-integrated conventional plans more than doubled, reaching around 14% in 2020.

Figueroa discussed the findings on the May 30 episode of Health Affairs’ podcast, A Health Podyssey.

“While there is reassuring growth in integrated programs, the growth has been small and we still have a long way to go, with over 90% [of dual-eligibles] not in integrated plans,” he said. “We know the bifurcated system is not working. We know it leads to fragmentation [lack of coordination of care from different health care providers] and we know it leads to higher costs.”

“There’s probably a few things that we can do as a country,” he continued. “The first thing is to really make fully integrated models the primary model of care. It should not be 90% in non-integrated plans and 10% only in integrated plans. The second thing is default enrollment, where as soon as someone qualifies for dual eligibility, they’re defaulted into an integrated plan that exists where they are.”

Listen to the podcast: José Figueroa on the State of Dual Eligibles in Integrated Care Programs