Integrated Care and Health Outcomes for Dual Eligible Individuals

This report examines how integrated care models served full-benefit dually eligible Medicare‑Medicaid beneficiaries in 2021. It compares three types of integrated plans—PACE, FIDE‑SNPs, and D‑SNPs—to standard Medicare Advantage plans, with a focus on hospitalizations, emergency department visits, nursing facility use, home‑ and community‑based services, and mortality. Using CMS data and matching to ensure appropriate comparisons, the study found that PACE participants had notably fewer hospital and ED visits and lower mortality, while FIDE‑SNPs and D‑SNPs show a more mixed pattern. FIDE and D-SNP enrollees were more likely to use hospital and ED services, yet they had far less institutional care, greater access to home‑based services, and lower mortality than similar Medicare Advantage enrollees. Overall, the findings point to integrated models playing an important role in improving outcomes for people with complex needs, while also highlighting areas where integration approaches vary in effectiveness.