The Effects of Care Coordination on Service Utilization for Individuals Dually Enrolled in Medicare and Medicaid: Evidence From the Washington Health Home Managed Fee-For-Service Demonstration.

This article evaluates the impact of Washington state's Health Home Managed Fee-For-Service (MFFS) demonstration, part of the Medicare–Medicaid Financial Alignment Initiative (FAI), which aims to improve care coordination and reduce costs for high-cost, high-risk individuals dually enrolled in Medicare and Medicaid. Using a modified regression discontinuity design based on the Predictive Risk Intelligence SysteM (PRISM) eligibility threshold, the study finds that for relatively healthier enrollees near the eligibility cutoff, the demonstration modestly reduced emergency department visits, ambulatory care visits, and certain home and community-based services, and decreased nursing facility stays among older beneficiaries, but had no significant effect on inpatient hospitalizations or skilled nursing facility admissions. The findings suggest that while care coordination through health homes may influence some service utilization patterns, the effects are limited for lower-risk enrollees, highlighting ongoing challenges in addressing fragmented care for dual enrollees. The study underscores the need for carefully designed and adequately funded integrated care models to effectively improve outcomes and reduce inefficiencies in this population.