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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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 OpinionWhat does this mean?