Bright Spots in Care Management in Medicare Advantage

This report, released by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care on behalf of the Better Medicare Alliance (BMA), identifies five key elements essential to effective care management to meet the needs of Medicare beneficiaries. These include:

1. A Value-Based Payment System with aligned incentives that promotes flexibility and innovation.
2. A Culture of Care Management that invests infrastructure and personnel resources to create and maintain a new culture organization-wide.
3. Effective Teams that co-locate care managers with care providers to enhance communication.
4. Customized Care that identifies patient needs and uncovers resources, competencies, goals, preferences, and values of the patients.
5. Trust that cultivates patient buy-in.

The report goes on to examine four successful models of care management through extensive interviews with Medicare Advantage and care management experts, an environmental scan, and field visits to the following Medicare Advantage financed care management programs:

• CareMore, a Medicare Advantage payer and provider aligned model that utilizes teams to manage chronic diseases and transitions of care for 80,000 Medicare Advantage beneficiaries in California, Nevada, Arizona, Ohio, Virginia, Georgia, Iowa, and Tennessee.
• Indiana University Health Methodist Hospital, a regional facility that utilizes the GRACE Model to provide care management teams that facilitate in-home care to 11,000 Medicare Advantage beneficiaries.
• InterMed, a physician-owned medical group that provides care management services facilitated through a pod structure that fosters trust and continuity for 4,400 Medicare Advantage beneficiaries in Maine.
• Johns Hopkins Medicare Advantage Plan, a payer utilizing care managers and community health workers to care for 5,000 Medicare Advantage beneficiaries in Maryland.