Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. E. Summary


The case study MCOs went beyond the Medicare fee-for-service benefits in all the I-CAN areas: identification, care management, assistance programs, and networks. They clearly used the flexibility provided by capitation to implement efforts that they thought would improve care and generate savings. These efforts tended to be fairly focused, however. For example, their care management programs emphasized assessments, feedback to primary care physicians, and referral to appropriate community-based social service providers. They did not include the long-term monitoring, patient education, and advocacy that have been part of many other care management efforts that have received major policy attention, such as the National Long Term Care Demonstration (Carcagno and Kemper 1988). In the next chapter, we will see how our sample of high-risk seniors enrolled with these organizations viewed the net effect of these innovations.

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