A Primer on Managed Care: Multiple Chronic Conditions

and care management. Second are the opportuni- ties available in Special Needs Plans (SNP) in MA, and third are the increasing flexibilities available to MA plans to offer supplemental benefits. Person-centered care management Integrated care is built upon several principles essential to its success in addressing the needs of people who have serious chronic conditions. A 2017 report sponsored by the Better Medicare Alliance and issued by the Robert Graham Cen- ter highlighted several primary care providers and identified the essential elements of success- ful care management (Better Medicare Alli- ance, 2018). The findings and showcased examples all indicate that successful person-centered care management requires the following: √ A financing mechanism that offers finan- cial incentives for improved outcomes over vol- ume of services, encourages innovation, and allows flexibility to meet the person’s needs; √ An organizational culture that promotes and supports care management, invests in the neces- sary infrastructure of staff and operations, and supports sustained staff education and training; √ Effective teams that routinely communi- cate with each other, define roles and responsi- bilities, and attend to care transitions; √ Active use of risk stratification data to identify and address peoples’ needs, individu- alized care plans that are operationalized, and actions aimed at removing barriers to care; and √ Trust among providers at all levels, rec- ognition of the need to build relationships with each other and with the people under their care, and shared decision-making. MA Special Needs Plans MA plans are using their risk-based, capitated systems to identify high-risk beneficiaries and to intervene and engage them early and where they are, both physically and mentally. One of MA’s unique aspects involves the opportunity to develop and implement SNPs for targeted popu-

Fourteen percent of older adults have six or more chronic conditions and need long-term-care management. care model that identifies the population, estab- lishes protocols for care coordination and care transitions, operationalizes a provider network appropriate to the population, and reports qual- ity measurements. Each beneficiary has a cus- tomized treatment plan. There are almost 700 SNPs across the country, and they are showing lower rates of hospitalizations, more care pro- vided in the home, and lower readmission rates. Supplemental benefits and new flexibilities in MA MA plans offer supplemental benefits not cov- ered in traditional Medicare. These benefits are offered using rebate dollars available to plans that bid below the adjusted benchmarked cost for traditional Medicare beneficiaries. These rebates also are adjusted based on the plans’ quality performance, with high-quality plans receiving an extra financial bonus for meeting quality measurements. The plans are required to use these rebate dollars to directly benefit their enrollees. Such benefits include reduced cost-sharing, dental, vision, and hearing ben- efits, wellness programs, and, more recently, telemedicine. Almost all plans offer at least one addi- tional benefit and 50 percent of plans offer at least three supplemental benefits. Due to the CHRONIC Care Act’s enactment, the types of benefits that plans can offer have been limited lations with complex needs. SNPs may target populations of people who are frail, have disabil- ities, or are chronically ill. There are three types of SNPs: D-SNPs available for those individuals who are dually eligible for Medicare and Medi­ caid; C-SNPs for people with chronic conditions; and I-SNPs for individuals who are eligible for institutional care. Each type of plan is required to establish a

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