Gartner Research

Healthcare Payer CIOs Can Avoid Pitfalls and Harness Opportunities of the Medicare-Medicaid Dual Demonstration

Published: 09 January 2017

ID: G00319947

Analyst(s): Bryan Cole

Summary

The U.S. Centers for Medicare & Medicaid Services' dual demonstration programs aim to integrate Medicare and Medicaid for high-need beneficiaries. CIOs at payers participating in or considering entering the demonstration should avoid these pitfalls to achieve success.

Table Of Contents

Analysis

  • FAI Program Structure Impedes State and Federal Policy Goals
  • Payers' FAI Results Have Been Disappointing
  • A Stand-Alone FAI Investment Does Not Make Financial Sense
  • Top Challenges and Recommendations
    • CMS FAI Does Not Allow CIOs to Truly Integrate Medicare and Medicaid Operations, Increasing IT Workloads
    • Overly Prescribed State and Federal Care Management Models Force CIOs to Implement Care Management and Reporting Application Work-Arounds
    • Capitation Funding Is Often Insufficient, Constraining IT Budgets Allocable to MMP

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