The U.S. Government Accountability Office (GAO) recently released a report examining the Centers for Medicare & Medicaid Services (CMS) program Financial Alignment Demonstration, which was designed to integrate Medicare and Medicaid services for dual-eligible beneficiaries. In its report, the GAO noted that effective care coordination for dual-eligible beneficiaries may be particularly difficult:
Certain characteristics of dual-eligible beneficiaries, such as high levels of transience, can make it challenging to coordinate their care—one of the key goals of the demonstration. … interviews with beneficiary advocacy groups and providers raised questions about the extent to which care coordination is actually occurring.
Coupling the transient tendencies of dual-eligible beneficiaries with the flexibility in implementation afforded to states participating in the program, the GAO determined that not enough comparable data exists to assess how well the program is working:
Because not all of the information that CMS collects to examine the extent to which care coordination is occurring is comparable, CMS does not fully know whether it has achieved its goal of providing coordinated care to dual-eligible beneficiaries. Establishing additional measures that would allow CMS to obtain these data could help it better understand the reasons why care coordination is or is not occurring and thus help the agency to strengthen the demonstration.
The bottom line? The success of a care coordination program cannot be measured without meaningful, comparable metrics.