To succeed in this era of health system transformation, plans and providers bearing risk – in an accountable care organization (ACO) for example – will need strategies for managing a broad array of care needs for high-risk beneficiaries across multiple settings of care. Download this fact sheet to learn more.Date Updated: 09/01/2014
A perfect storm of events is driving payers and providers to better manage the cost of their high-risk Medicare beneficiary population—dramatic changes in Medicare payment policy, growth in Medicare Advantage (MA) plan enrollment, and the aging population will make it impossible to avoid increasing financial risk. To succeed in this era of health system transformation, plans and providers bearing risk – in an accountable care organization (ACO) for example – will need strategies for managing a broad array of care needs for high-risk beneficiaries across multiple settings of care. One data collection tool that offers a particularly strong opportunity to improve identification of high-risk members is the health risk assessment (HRA).
HRAs are able to identify health behaviors and risk factors that would not be picked up in claims data, generating a more complete picture of the member.
To evaluate the state of HRAs used by payers, Avalere Health reviewed government regulations and relevant literature, and conducted interviews with HRA experts to understand common HRA practices, potential shortcomings, and recommendations for improvements…
Download the publication for all visuals and complete references.
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.
High quality, cost effective health care delivery is all about targeting – the right care, by the right provider, at the right time, in the right place, and for the right cost. It sounds straightforward, almost easy. The challenge to getting it right is understanding the range of variables in a person’s life that drive health care use and costs. Find out more in this week’s Perspectives.
Chances are you know and love an older person with needs. Maybe it’s that neighbor of yours whose trash cans you help bring in once a week. Perhaps it’s your grandparent or even a parent who needs help understanding the bills or getting the groceries up the stairs. The reality is the population of older adults in this country is growing rapidly due in large part to the aging of baby boomers – a demographic shift that affects us all. Advancements in health care and technology have also spurred this phenomenon, yet we know that a longer life also brings a greater likelihood of facing multiple chronic health conditions and possibly needing help with everyday activities.