Improving Care for High-Need, High-Cost Medicare Patients

Peter Fise
April 2017

This report recommends policy changes so that Medicare can pay for non-medical supports and services, such as meal delivery, transportation, and case management, to improve outcomes and lower costs for patients with complex needs.

  • Evidence suggests that non-medical services and supports could help avoid costly emergency care for frail and chronically ill Medicare beneficiaries.
  • This analysis defines people with complex needs as those beneficiaries who are not dually eligible for Medicaid, live at home, have three or more chronic conditions, and have functional limitations.
  • The analysis projects that Medicare spends about $30,000 per patient annually on caring for people with complex needs, more than twice the average of Medicare fee-for-service patients.
  • The report recommends that the Centers for Medicare and Medicaid Services make specific changes in regard to rules and regulations in the following areas: risk adjustment and quality measurement incentives, Medicare Advantage, and accountable care organizations and medical homes.
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
  • How much does Medicare spend on patients with complex needs as compared to other patient populations?
  • Which social services might Medicare cover to improve outcomes for patients with complex needs?
  • What policy changes are necessary to allow Medicare to cover non-medical services?
  • What are the limitations of these recommended policy changes?
Level of Evidence
Expert Opinion
What does this mean?