The Medicare-Medicaid Coordination Office and many of the 15 contracted states are proposing to integrate models and services in ways and at a level that have not been tried before. Care must be taken to ensure that working delivery systems are not dismantled or interrupted before new systems have proved that they can reliably deliver care. It is important that MMCO, the states, and the integrated models continue to design and implement plans thoughtfully and deliberately. Where possible, integration should take place in phases, starting with simple steps that build off of the current structures in place, and then progressing towards more significant changes as necessary and appropriate.

Phases can vary depending on the circumstances. For example, the enrollment process may be phased. The first year of the implementation could target a smaller number of enrollees with increasing goals for enrollment in future years. Another option may phase in expansion by the geographic area that a model serves, starting in a community where it is rooted before reaching out to other areas. Yet another approach could be to integrate more and more services into the model over time. For example, an integration model might take over financial responsibility for all services in its first year of implementation, but contract with existing mental health and home and community-based service structures in the early years. Over time, the model may find ways to introduce uniform assessments and other tools that would increase the degree to which these services are integrated.