Effective Management of High-Risk Medicare Populations

Sally Rodriguez
Dianne Munevar
Caitlin Delaney
Lele Yang
Anne Tumlinson
September 2014

This resource, drawing on Medicare survey and claims data, a literature review, and interviews, suggests a three-pronged strategy to manage care for Medicare beneficiaries with medical and social needs.

  • The first step is to pinpoint the relevant risk factors, including functional and cognitive impairments.
  • The next step is to improve data collection, such as by adding questions to existing health-risk assessments that go beyond the usual medical and financial questions.
  • Finally, you should implement targeted programs to manage transitions and coordinate care for high-risk members.
  • The study’s analysis of return on investment (ROI) indicates that targeted care coordination programs can yield an ROI of 250 percent.
Posted to The Playbook on
Population Addressed
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • Which psychosocial factors should I take into account to identify high-risk Medicare beneficiaries?
  • Who are individuals with complex needs?
  • Why invest in models of care to improve care for individuals with complex needs?
  • What care models work to improve care for individuals with complex needs?
Level of Evidence
What does this mean?