Improving Care for High-Need, High-Cost Medicare Patients

Authors
Peter Fise
Brief/Report
April 2017

This report recommends policy changes so that Medicare can pay for non-medical supports and services, such as meal delivery, transportation, and case management, to improve outcomes and lower costs for patients with complex needs.

  • Evidence suggests that non-medical services and supports could help avoid costly emergency care for frail and chronically ill Medicare beneficiaries.
  • This analysis defines people with complex needs as those beneficiaries who are not dually eligible for Medicaid, live at home, have three or more chronic conditions, and have functional limitations.
  • The analysis projects that Medicare spends about $30,000 per patient annually on caring for people with complex needs, more than twice the average of Medicare fee-for-service patients.
  • The report recommends that the Centers for Medicare and Medicaid Services make specific changes in regard to rules and regulations in the following areas: risk adjustment and quality measurement incentives, Medicare Advantage, and accountable care organizations and medical homes.
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Key Questions Answered
  • How much does Medicare spend on patients with complex needs as compared to other patient populations?
  • Which social services might Medicare cover to improve outcomes for patients with complex needs?
  • What policy changes are necessary to allow Medicare to cover non-medical services?
  • What are the limitations of these recommended policy changes?
Level of Evidence
Expert Opinion
What does this mean?