Medicare Risk Plans and Disease Management Vendors: Present and Future Relationships
Although Medicare risk plans have been withdrawn in a number of US geographical areas, the size and dollar value associated with the senior demographic group is too large for health plans to ignore. Unlike other developed nations, the US government offers to Medicare-eligible citizens a choice between payment methods for health services. The fee-for-service reimbursement system (Medicare Parts A and B) has been in effect for 30 years; capitated prepaid Medicare risk plans (Medicare+Choice), the subject of this article, are a more recent addition. Active discussion has emerged on how best to pursue disease management in the Medicare risk environment. Disease management must constructively address comorbidities and realise bottom-line medical management savings. With limited medical management resources and a requirement for near-term results, successful programmes will anticipate and concentrate on the tiny fraction of members who generate a large portion of costs. In the future, health plans will make use of the Internet to share essential information across fragmented delivery systems and individually engage seniors, who are increasingly on-line, in their care.
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