Perspectives: Defining the Business Case for Targeted Care Coordination


A new report and series of briefs from Avalere Health commissioned by The SCAN Foundation explore how gathering and using non-medical data to better coordinate care for high risk Medicare beneficiaries can improve person-centered care and be financially sustainable for health plans.

Date Updated: 09/23/2014

There is an old story about a man, who having lost his car keys in the dark, looks under the lamppost for them because that’s where the light is – and of course, doesn’t find the keys. This story plays out in health care too, where health plans use easily available administrative claims data to seek understanding of their population. However, if your population includes chronically ill people who have substantial daily living challenges which are known to drive up costs, administrative data won’t tell you much about their everyday needs and potential solutions to those needs. Therefore, the critical question is this: how can health plans become more person-centered by using different analytic tools to understand and meet the needs of their vulnerable populations while maintaining a return on investment…

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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.