Challenges and Opportunities in Caring for High-Need, High-Cost Medicare Patients

Authors
Katherine Hayes
G. William Hoagland
Matthew McKearn
Peter Fise
Marisa Workman
Rachel Meltzer
Report
February 2017

This resource analyzes a number of specific care models that serve Medicare-only individuals and enumerates five main policy barriers and potential strategies to address these barriers.  

  • The specific care models analyzed in this report include: Medicare Advantage, (MA) plans, MA Dual-Eligible Special Needs Plans (D-SNPs), Medicare Shared Savings Program (MSSP), Accountable Care Organizations (ACOs), Next Generation (NextGen) ACOs, Comprehensive Primary Care Plus (CPC Plus) Model Participants,  Programs for All-Inclusive Care for the Elderly (PACE) Organizations.
  • The five principle policy issues analyzed in this report include: MA supplemental benefit rules, MA uniform benefit requirements, medical loss ratio application, program integrity rules (anti-kickback and beneficiary inducement), marketing restrictions on communications with beneficiaries, and financial and non-payment barriers.
  • This resource presents initial policy solutions for each barrier identified. The Bipartisan Policy Center will issue final recommendations in April of 2017.
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Population Addressed
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • What are current regulatory, payment, and other barriers for Medicare-only health plans and alternative payment organizations seeking to provide interventions and social supports which are not covered under the traditional Medicare Part A or Part B benefit?
  • What are policy options that might address these barriers?
Level of Evidence
Expert Opinion
What does this mean?