A Primer on Managed Care: Multiple Chronic Conditions

Medicare Advantage: Modernizing Medicare Through Innovation in Financing and Care Delivery By Allyson Y. Schwartz

Medicare Advantage plans, which are improving patient outcomes, offer a better path forward for Medicare.

‘The fee-for-service system created by traditional Medicare is fragmented and ill-suited for today’s needs.’ no sector will be more adversely affected than the healthcare system. With 10,000 people turning age 65 every day, the number of older Americans is projected to double in the next few decades, growing from 48 million in 2018 to 98 million by 2060, at which point nearly one in five Americans will be ages 65 or older. Howwe meet these new demands on the healthcare system is an ongoing conversation inWashington, D.C., with an expected divide breaking down on whether the answer is to cut spending or garner new revenue, or enact some combination of the two. While policy makers are T he aging of our nation’s population will place new demands on every sector of society, and

focused on the financial pressures onMedicare (as the largest payer of healthcare for older adults), there is an increasing realization that an impor- tant part of the solution is to modernize Medicare financing and care delivery to better to meet the needs of today’s and tomorrow’s older adults. Medicare Beneficiaries’ Changing Healthcare Needs The health needs of older Americans have changed dramatically over time. The healthcare financing system established in 1965 with Medi- care was designed to meet the concerns and real- ity of the day. Fifty years ago, older Americans needed help to pay for acute episodes of care that meant a hospital stay, which was unafford- able for most elders. Medicare addresses these expensive hospitalizations and accompanying services by covering the majority of the cost of hospital stays, associated physician services, tests, and procedures. Providers are reimbursed

abstract Older adults are living longer with more chronic conditions and benefit from person- centered care that also addresses social determinants of health. Integrated, value-based care can better serve the Medicare population’s changing healthcare needs. This article explores the way Medicare Advantage (MA) is modernizing Medicare financing and care delivery to meet the needs of today’s and tomorrow’s older adults, and how MA plans have shown improved outcomes for beneficiaries with chronic illness. | key words : t raditional Medicare, Medicare Advantage, chronic conditions, social determi- nants of health, integrated care, person-centered care, value-based care

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