Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. CHAPTER IV. KEY ELEMENTS IN MANAGING CARE FOR HIGH-RISK SENIORS


Faced with the need to serve high-risk seniors who are characterized by their variability, impairments, and use of multiple providers managed care organizations (MCOs) can draw on several approaches. As noted in Chapter I, we have organized these approaches under the I-CAN acronym: Identification, Care Management, Assistance programs, Networks.

This chapter examines how our case study MCOs used these four approaches to improve care for high-risk seniors. In particular, we examine the innovations these organizations made, relative to the care systems typically found in the Medicare fee-for-service sector. These innovations suggest ways in which Medicare + Choice can improve care for high-risk seniors. They do not, however, represent the general performance of Medicare + Choice plans, as we deliberately selected the four case study organizations because they had innovative programs. In addition, activities at the four case study organizations show only what is possible within the current Medicare + Choice system. Options such as Social Health Maintenance Organizations and the Program of All Inclusive Care for the Elderly (PACE) offer wider potential because of their more generous funding and benefit packages (Medicare Payment Advisory Commission 1999).

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