New Opportunities for Serving Complex Care Populations in Medicare Advantage
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.Date Updated: 12/12/2018
- The Medicare Advantage population with complex care needs now mirrors beneficiaries in fee-for-service in that health plan members experience functional impairment and other markers of complexity at the same rate as fee-for-service.
- Functional impairment and other markers of complexity, such as chronic conditions, are strongly associated with high health care spending.
- Health plans that adopt care delivery innovations for complex care populations will create value and reduce spending.
- Today, health plans have flexible benefit tools in the Medicare Advantage program.
- The time is now! Plans will need to deploy these tools and adopt innovations to serve a rapidly growing group of members age 75 and older…
This policy brief establishes a basis for the critical system transformation activities necessary to produce a high quality, person-centered system of care for older adults and people with disabilities.
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.
People tend to be very satisfied with their long-term care providers when they start their care, but satisfaction decreases over time.