publication

Medicare

Federal health coverage for older Americans


Today, health plans have flexible benefit tools in the Medicare Advantage program. With data analysis by Anne Tumlinson Innovations, this slide deck discusses how health plans can deploy these tools and adopt innovations to serve a rapidly growing group of members age 75 and older.
For most Americans, higher health care spending has not translated into improved quality, particularly for those with complex medical or social needs. In this Perspectives, Dr. Chernof discusses the impact of the CHRONIC Care Act as a path to better care for older adults.
This policy brief highlights 10 questions health plans and systems nationwide could consider using in their risk assessments to deliver more cost-effective, quality care.
The CHRONIC Care Act was passed and signed on February 9, 2018. This policy brief provides a summary of key components of the law.
Immediately following the 2016 presidential election, Dr. Chernof wrote a letter to then President-elect Trump describing five action items for supporting older Americans.
The number of individuals age 65 and older across the nation is projected to double in the next 50 years, from over 45 million in 2015 to over 95 million in 2065. California's age 65 and older population stands at 4 million, which is projected to double to over 8 million by 2030. This brief offers a basic primer on long-term services and supports (LTSS) in California within a national context. LTSS, also known as long-term care (LTC), provides assistance to people with disabilities of all ages, including older adults who need help with daily activities.
As Medicare moves away from fee-for-service and utilization-based managed care to value-based purchasing, addressing older adults’ health in light of functional needs is becoming a business necessity. In this Perspectives, Dr. Chernof recognizes delivery systems that champion person-centered care as the practical way of the future and introduces two resources to help health systems leaders justify and ramp up greater adoption of person-centered care models.
Person-centered care works for older adults with chronic health conditions and daily living needs, but how does it apply to health care organizations?  Is it financially sustainable?  Is there a return on investment?  This issue brief, based on a full report – Person-Centered Care: The Business Case – shows how person-centered care can result in fewer hospitalizations and emergency room visits while increasing one’s quality of life.
A white paper and series of briefs from Avalere Health produced with support from The SCAN Foundation explore the use of non-medical data to better coordinate care for high risk Medicare beneficiaries, which can lead to improvements in care while providing health plans a return on investment.
In this paper, the National Committee for Quality Assurance (NCQA) discusses prior integration efforts; introduces a model for integrated entities and a framework for assessing and promoting quality of integrated care; and explores the challenges to implementing and achieving the goals of person-centered, integrated care for Medicare-Medicaid beneficiaries. They use the word “framework” to describe the key concepts underlying the structure and process measures; it can also be expanded to include the content of performance measures as companions to the structure and process measures.
The California Medicaid Research Institute (CAMRI) compiled a report that identifies Californians who receive home-and community-based support and what services they receive. The brief brings together available information spread across multiple state and federal data systems.
In this brief, the California Medicaid Research Institute documents its process to acquire and link all the data sources necessary to evaluate long-term care services utilization, costs, and outcomes in California. This provides useful information about how data currently flows in the state and how system transformation can be supported.
This policy brief is the first of two publications from Georgetown University on transforming models of care. The paper affirms that in order to improve care delivery and manage costs, innovations for Medicare beneficiaries who have both chronic conditions and functional impairments should be a top priority.