Just a few years ago, nearly all of the 11 million people in the U.S. who are dually eligible for Medicare and Medicaid had to navigate two separate, almost entirely disconnected systems of care. In 2012, the nation spent more than $300 billion on care for the members of this high-need group who often have multiple chronic conditions, physical or behavioral health disabilities, and functional limitations. This results in:

• Limited provider communication and uncoordinated services;
• Poor health outcomes;
• Unaligned policies for reimbursement, beneficiary protections, and enrollment — and related beneficiary confusion;
• Cost-shifting; and
• Avoidable spending.