Managing Effectively in Complex Chronic Care Markets

Paper
Key Questions Answered
  • What are the key challenges of providing complex chronic care?
  • What are the ingredients of effective models?
  • What are some examples of organizations currently using these approaches?
Key Themes and Takeaways

This resource provides a roadmap for health plans providing complex chronic care to improve quality and their Medical Loss Ratio (MLR), a basic financial measurement used in the Affordable Care Act to incentivize health plans to provide value to enrollees.

  • Challenges of providing complex chronic care include working in office-based settings, lack of care coordination across specialists and facilities, and misaligned financial incentives.
  • An effective model requires a patient-centered model of care, specialized expertise, advanced technology and analytics, and aligned risk-based payment.
  • The resource includes case studies of approaches tried by seven different organizations, including a deep dive into home-based primary care provider Landmark Health.
Population Addressed
People with Multiple Chronic Conditions
Level of Evidence
Expert opinion
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