Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. A. Variability


Variability among high-risk seniors is important because of the ways in which it can complicate their care. First, the risks faced by this group stem from many different combinations of chronic illnesses and functional limitations. Careful assessment is required to assess the full range of an individual’s health and functioning needs and the appropriate medical care, therapies, and assistance with daily living. Second, the symptoms of chronic illnesses can vary substantially over time and so need to be monitored carefully. Treatments for a chronic illness depend on its course, so providers must know whether its symptoms have recently been worsening or improving before they can make appropriate treatment decisions. Finally, seniors differ in their attitudes and abilities. These differences affect how they negotiate the care system, follow treatment regimens, and respond to changes in their health or functioning.

Variability is also important because of the need to ensure that all groups have appropriate access to care. In particular, there are some groups of high-risk seniors for whom adequate care will probably require special efforts. Among the general Medicare population who are healthy or have only occasional acute illnesses, the consequences of delays in care may not be particularly problematic. However, among high-risk seniors, delays can lead to serious complications in their conditions and complicate care delivery (Stone et al. 1987). Thus, organizations that want to serve high-risk seniors will have to pay special attention to early identification and assessment.

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