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

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.

BPC’s work will address pressing policy questions that have been raised by the Senate Finance Committee Chronic Care Working Group, federal policymakers, Medicare ACOs, and others seeking to improve outcomes, lower out-of pocket costs, and reduce overall spending for the sickest Medicare beneficiaries.