Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. D. Networks


The case study organizations illustrated ways in which the development, organization, compensation, and monitoring of provider networks can promote better care for high-risk seniors. The organizations established quality criteria for skilled nursing facilities and home health agencies in their networks. They developed ways to promote more intensive monitoring of facility-resident patients than would typically occur in the fee-for-service sector. They found ways to introduce more flexibility into the care process and so ended up covering some activities that rarely would be paid for under Medicare fee-for-service policies. Finally, the group model organizations, Aspen and Kaiser Colorado, promoted a culture of experimentation where their physicians felt comfortable proposing and testing new ways of improving the care delivered to high-risk seniors.

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