Nearly 12 million individuals are enrolled in both Medicare and Medicaid. This “dually eligible” population face significant challenges in receiving well-coordinated care that is aligned with their needs.

Andrew McClure of Senior Whole Health, a Magellan company, discusses his work around aligning quality measurement and improvement and offers insight on what drove the success of this partnership between medical group providers and this special needs health plan.

To achieve the quality and cost outcomes we seek, Medicare and Medicaid services must be coordinated through one unified plan. And in some cases, this is already happening.

The Program of All-Inclusive Care for the Elderly provides comprehensive, compassionate medical care and long-term services and supports to older adults with persistent complex needs who are eligible for nursing home care. Yet, PACE reaches less than two percent of those who could benefit from its services.

Congress recently passed a federal budget incorporating the CHRONIC Care Act that capitalizes on and grows early successes in many of these programs.