title: Innovative care models for high-cost Medicare beneficiaries: delivery system and payment reform to accelerate adoption.
abstract: OBJECTIVE
  About a third of Medicare beneficiaries are covered by Medicare Advantage (MA) plans or accountable care organizations (ACOs). As a result of assuming financial risk for Medicare services and/or being eligible for shared savings, these organizations have an incentive to adopt models of delivering care that contribute to better care, improved health outcomes, and lower cost. This paper identifies innovative care models across the care continuum for high-cost Medicare beneficiaries that MA plans and ACOs could adopt to improve care while potentially achieving savings. It suggests policy changes that would accelerate testing and spread of promising care delivery model innovations.
  
  
  METHODS
  Targeted review of the literature to identify care delivery models focused on high-cost or high-risk Medicare beneficiaries.
  
  
  RESULTS
  This paper presents select delivery models for high-risk Medicare beneficiaries across the care continuum that show promise of yielding better care at lower cost that could be considered for adoption by MA plans and ACOs. Common to these models are elements of the Wagner Chronic Care Model, including practice redesign to incorporate a team approach to care, the inclusion of nonmedical personnel, efforts to promote patient engagement, supporting provider education on innovations,and information systems allowing feedback of information to providers. The goal of these models is to slow the progression to long-term care, reduce health risks, and minimize adverse health impacts, all while achieving savings.These models attempt to maintain the ability of high-risk individuals to live in the home or a community-based setting, thereby avoiding costly institutional care. Identifying and implementing promising care delivery models will become increasingly important in launching successful population health initiatives.
  
  
  CONCLUSIONS
  MA plans and ACOs stand to benefit financially from adopting care delivery models for high-risk Medicare beneficiaries that reduce hospitalization. Spreading these models to other organizations will require provider payment policy changes. Integration of acute and long-term care would further spur adoption of effective strategies for reducing or delaying entry into long-term institutional care.
authors.affiliation: 624 N Broadway, Rm 693, Baltimore, MD 21205. E-mail: karen.davis@jhu.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Davis
authors.forename: Christine
authors.initials: C
authors.lastname: Buttorff
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Quincy M
authors.initials: QM
authors.lastname: Samus
authors.forename: Sarah
authors.initials: S
authors.lastname: Szanton
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Farhan
authors.initials: F
authors.lastname: Bandeali
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000458:organization & administration*; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy*; D017046:Cost Savings; D018450:Disease Progression; D006801:Humans; D020398:Medicare Part C / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration; D014481:United States