« The Dual Agenda: February 24, 2016 Issue

Featured Resources

Health Care Transformation Task Force White Paper on Best Practices in Caring for High-Need, High-Cost Patients

The Health Care Transformation Task Force, a consortium of patients, payers, providers and purchasers working to transform the U.S. health care system, released a white paper that identifies the building blocks of successful care management for high-need, high-cost patients, presents case studies of Task Force member care management programs, and identifies lessons learned and important areas for improvement.

The paper – “Developing Care Management Programs to Serve High-Need, High-Cost Populations”– draws on the evidence and experience of clinically and financially successful programs across the country.

Experts from the Task Force’s Improving Care for High-Cost Patients Work Group, composed of Task Force members and partner organizations, identified five lessons learned and opportunities for improvement:

  1. Ensure Meaningful Patient and Caregiver Engagement – Engage patients and informal caregivers, including family, at all levels of care delivery is integral to the success of care management programs. At the community level, patients and caregivers can help bridge a potential gap between acute care and community-based care management resources.
  2. Evaluate Care Management – The Task Force recommends that care management programs include processes for evaluating patient-reported outcomes (PROs) and low- or no-value care.
  3. Define the Scope of Care Management Programs – There is no one-size-fits-all approach for care management. Each program serves its own patient population, reflective of local demographics.
  4. Tailor Care Management Programs to Individual Patients – Successful care management programs respond to the specific needs of the patient. This is made possible through the establishment of a trusting relationship at the outset of care.
  5. Overcome Resistance to Services – Providers who are philosophically aligned with the program, have a track record in improvement, and who are financial invested in the program’s success may provide the strongest leadership for an effective program. For patients, education, patience, empathy, and peer support are critical in overcoming the fear, anxiety, shame, distrust, or other factors that may influence patient resistance to services.

The white paper is the second in a series of three papers to be developed by the Task Force’s Improving Care for High-Cost Patients Work Group. The first paper focused on methods to identify high-need, high-cost patients. The third paper will offer guidelines to develop payer-provider relationships that promote sustainability of proven innovations.

Paper Examines Coordinated Appeals Process for Dual Eligibles in Integrated Programs

The National Health Law Program (NHeLP) released a paper examining the coordinated appeals process for dually eligible individuals in three programs: Program of All-Inclusive Care for the Elderly (PACE), the capitated dual eligible demonstration projects and Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). The paper examines how well these programs protect the rights of enrollees and identifies best practices for integration programs.

Funding Sources to Address Health-Related Social Needs

The National Academy for State Health Policy (NASHP) has developed a brief that brings attention to non-Medicaid funding sources that states could potentially access to address the social and economic determinants of health. The brief also outlines a continuum of options for states seeking to coordinate funding to better serve the needs of low-income populations.

Supporting Low-Income Family Caregivers to Improve the Health of Older Adults

Justice in Aging released a report on strengthening the support system for low-income adults and caregivers. The report advocates for both strengthening the health and economic security systems that support older adults to relieve pressure on family caregivers, and simultaneously expanding existing and adopting new policies that support caregivers directly.

Subscribe to

The Dual Agenda Newsletter

Support Our Work:

Donate