Integration of Care for High-Cost, High-Risk Individuals: Policy Barriers and Solutions


There is growing consensus that coverage of nonclinical services targeting social and economic needs can improve health, particularly for patient populations with high needs and high costs. People with multiple chronic conditions, who account for 93 percent of Medicare spending, are one such population. Building on work funded by the Peterson Center on Healthcare to scale and spread successful models of dual-eligible care, this project will seek ways to improve care coordination and integration of clinical care with community-based social services, focusing on people eligible for Medicare only. Staff at the Bipartisan Policy Center (BPC) will identify legal, policy, and fiscal barriers—including perceived obstacles—to coverage of nonclinical services by a range of delivery and reimbursement models, including accountable care organizations (ACOs), Medicare Advantage, risk-based medical homes, and the Program of All-Inclusive Care for the Elderly (PACE). The BPC team will first identify common practices among private insurers and self-funded plans with a history of providing community-based services, such as meals for people with difficulty meeting basic dietary needs for their chronic conditions. The team will then develop policy options to overcome the barriers identified and, in collaboration with The Commonwealth Fund, convene experts from all stakeholder groups to vet these options. Finally, BPC will work with analysts at Acumen to quantify the cost and budgetary implications of the proposed policy options.

Grant Details

Grantee Organization:
Bipartisan Policy Center, Inc.
Principal Investigator:
Katherine Hayes, J.D.
Award Amount:
Approval Date:
April 12, 2016
Related Topics
Health Care Delivery

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