title: Integrated Medicare and Medicaid managed care and rehospitalization of dual eligibles.
abstract: OBJECTIVE
  Healthcare expenditures for dually eligible individuals covered by both Medicare and Medicaid constitute a disproportionate share of spending for the 2 programs. Fragmentation, inefficiency, and low-quality care have been long standing issues for this population. The objective of this study was to conduct an early evaluation of an innovative program that coordinates benefits for elderly dual eligibles.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Comparable sources of administrative claims from 2007 to 2009 were used to examine differences in 30-day rehospitalization between dual eligibles in Massachusetts participating in Senior Care Options (SCO), an integrated managed care program, and dual eligibles in Medicare fee-for-service. Multivariable logistic regression models with county and time fixed effects were used for estimation.
  
  
  RESULTS
  We found no statistically significant effect of SCO on rehospitalization, an area where coordinated care would be expected to make a substantial difference.
  
  
  CONCLUSIONS
  Our results suggest that coordinating the financing and delivery of services through an integrated managed program may not sufficiently address the problems of inefficiency and fragmentation in care for hospitalized dual eligible enrollees.
authors.affiliation: Weill Cornell Medical College, 402 E 67th St, New York, NY 10065. E-mail: arj2005@med.cornell.edu.
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Jung
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000331:legislation & jurisprudence / Q000379:methods; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration; D005260:Female; D005376:Financial Management / Q000379:methods / Q000458:organization & administration; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D008484:Medicaid / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000191:economics; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D014481:United States