Insight into the Financial Alignment Initiative: Capitated Model Demonstrations

Open Access
Author:
George, Jonathon Thomas
Area of Honors:
Interdisciplinary in Finance and Health Policy and Administration
Degree:
Bachelor of Science
Document Type:
Thesis
Thesis Supervisors:
  • Mark Sciegaj, Thesis Supervisor
  • Caprice Knapp, Honors Advisor
Keywords:
  • Healthcare
  • Health Policy
  • Healthcare Policy
  • Financial Alignment Initiative
  • Dual Eligible
  • Medicare-Medicaid
  • Medicare
  • Medicaid
  • Capitated
Abstract:
Of the estimated 11.4 million Americans dually enrolled in Medicare and Medicaid programs, these “dual eligible” beneficiaries are among the sickest and most vulnerable patients in the United States. Because of the complexity these high-risk individuals, their needs are typically overlooked by standard health systems due to a lack of service coordination across Medicare and Medicaid providers. To address the lack of coordination among other concerns, the Centers for Medicare and Medicaid Services introduced the Financial Alignment Initiative in 2011, a nationwide demonstration that seeks to improve access to quality care and coordination of services for dual eligibles. This thesis provides an integrative study and discussion on the Financial Alignment Initiative and its California and Illinois demonstrations. Through literature review and data collection through interviews with federal, state, and third-party officials, we argue that by emphasizing further collaboration between federal decision-makers and health plans, focusing on administrative improvements across demonstrations, and refining meaningful data collection and evaluation techniques, results would lead to better care coordination, enrollment, and cost savings across demonstrations.