Innovations in Medicare Advantage to Improve Care for Seriously Ill Patients

Authors
Andrew Olson
Matthew Harker
Robert Saunders
Donald H. Taylor, Jr.
Brief
July 2018

This resource examines three innovative models for treating patients with serious illness, developed by third-party firms that contract with Medicare Advantage plans.

 

  • The financing structure of Medicare Advantage makes it a fertile testing ground for new approaches, including value-based payment models. For 2016, Medicare Advantage plans reported that more than 4 in 10 of their care dollars were paid through alternative payment models.
  • Several new models have been developed by third-party firms. A common approach is to deliver care management and high-touch, non-medicalized services.
  • The three models examined here have several common features. They: analyze claims data to identify eligible patients; regularly assess patients; deliver care to patients in their residence; and provide round-the-clock accessibility to patients.
  • To diffuse these models, policymakers should provide incentives to encourage innovation; study these new programs to expand the evidence on utilization, quality, and cost; and support workforce development to train clinicians for roles in alternative payment model care teams.
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Population Addressed
People with Advanced Illness
Key Questions Answered
  • What lessons can be learned from innovations in treating patients with serious illness through Medicare Advantage?
  • How can these innovations be diffused to other types of plans throughout the health system?
Level of Evidence
Expert Opinion
What does this mean?