For High-Risk Medicare Beneficiaries: Targeting CMMI Demonstrations on Promising Delivery Models

Brief
Key Questions Answered
  • How should the federal government identify effective models to lower health care costs for high-risk beneficiaries of Medicare and Medicaid?
  • What are the most important problems to address in the current system for financing Medicaid and Medicare?
Key Themes and Takeaways

With major funding from the Affordable Care Act, the Center for Medicare and Medicaid Innovation (CMMI) is launching and evaluating several initiatives that change financial incentives to reward value-based rather than volume-based care delivery.

  • Thus far, most of these CMMI initiatives have not specifically focused on high-risk beneficiaries, even though this population has the highest-leverage opportunity for savings.
  • This resource proposes a second stage of innovation focused on high-risk beneficiaries in different settings, such as homes, senior day centers, hospitals, and nursing homes. The aim of testing these innovations is to lower costs as well as improve the quality of life and care satisfaction for beneficiaries and their caregivers.
  • It is critical to eliminate the silos that separate Medicare financing of acute care from Medicaid financing of long-term care. An integrated strategy is needed to line up incentives across the entire care continuum.
Authors
Karen Davis
Christine Buttorff
Bruce Leff
Quincy Samus
Sarah Szanton
Jennifer Wolff
Population Addressed
Frail Older Adults
People with Multiple Chronic Conditions
Level of Evidence
Expert Opinion
Uploaded to The Playbook