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

Peter Fise
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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