Innovations in Medicare Advantage to Improve Care for Seriously Ill Patients

Authors
Andrew Olson
Matthew Harker
Robert Saunders
Donald H. Taylor, Jr.
Brief/Report
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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