Targeting High-Need Beneficiaries in Medicare Advantage: Opportunities to Address Medical and Social Needs

Authors
Eva H. Dugoff
William Buckingham
Amy J. H. Kind
Sandra Chao
Gerard F. Anderson
Brief/Report
February 2019

Approximately one in three Medicare beneficiaries is enrolled in a Medicare Advantage (MA) plan, and more than one third of these MA enrollees are classified as high need based on their chronic conditions, age, and level of functional impairment. These high-need MA enrollees are more likely to have low incomes, live in disadvantaged neighborhoods, and report risk factors for social isolation – all contributing to a greater likelihood of poor health outcomes. This resource provides a summary of national and state-level data on the proportion of high-need enrollees among all MA beneficiaries, as well as data on the health and social characteristics of this population.

High-need beneficiaries require health and social services, and MA plans are able to, under the CHRONIC Care Act, offer nonmedical benefits to targeted beneficiaries beginning in 2020. This resource includes policy considerations for federal policymakers to use medical and social risk factors, rather than solely medical diagnoses, to identify high-need beneficiaries.

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Key Questions Answered
  • What are the health and social needs of Medicare Advantage enrollees?
  • What member characteristics should Medicare Advantage plans assess to effectively target services to meet member needs?
Level of Evidence
Moderate
What does this mean?