Managing Effectively in Complex Chronic Care Markets

Peer-Reviewed Article
February 2018

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.
Posted to The Playbook on