Strategic Framework from The Chartis Group Shows Health Systems How to Deliver Better Medicare Patient Outcomes at Lower Costs

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"Managing Medicare to Break Even" includes four strategic pivots for health systems to achieve better patient outcomes at lower costs

The Chartis Group today released a report, “Managing Medicare to Break Even: Better Patient Outcomes at Lower Costs.” Medicare growth is exploding, with a projected 48 percent increase in the number of beneficiaries by 2030 and total Medicare spending up 85 percent over the next five years, while Medicare margins continue to shrink. Many providers are struggling to improve patient outcomes for this high-risk, high-utilization population while containing costs. This report provides four strategic pivots for providers that will lead to improved Medicare outcomes and break even.

The traditional care delivery system was built for the general patient population and is not well-designed or suited to senior populations with a different set of requirements and long-term trajectory. While Medicare patients may require more frequent services or touches, such as quarterly chronic condition check-ins, the intensity of services should decline over time. Many providers deal with this population by continuously increasing the number and intensity of services. In contrast, supportive care and wraparound services positively impact stabilization and management of chronic conditions and, result in lowered intensity of services and improved quality of life. The Medicare population is unique and needs to be treated differently.

Melissa McCain, Director, Clinical Management and Patient Engagement and Access, and co-author of the paper noted, “To capture the full value of care improvements that providers are likely to undertake to break even or generate positive margin in Medicare, providers should proactively assess options to retool their approach to the Medicare population, which could include building capabilities to manage this population differently under risk arrangements.”

For most providers, effectively addressing the unique needs of the Medicare population will require pivoting away from a traditional mindset and approach, toward new models of care delivery and management. Below are summaries of the four strategic pivots needed to accomplish this goal:

Pivot 1 – Financial Position
Model Medicare patient utilization and develop care strategies and models that optimize Medicare economics.

Pivot 2 – Organizational Structure
Create an autonomous organization that can bring Medicare patient management capabilities to the delivery system for outcomes and contract success.

Pivot 3 – Care Model
Focus on interventions and services delivered by non-traditional roles to delay progression to frailty.

Pivot 4 – Time-Based Approach
Focus on cross-continuum, longitudinal care specifically for Medicare patients.

The report includes additional details on the four pivot strategies and a series of questions for providers to evaluate their Medicare organizational structure as well as their financial and clinical performance.

About The Chartis Group
The Chartis Group (Chartis) provides comprehensive advisory services and analytics to the healthcare industry. With an unparalleled depth of expertise in strategic planning, performance excellence, informatics and technology, and health analytics, Chartis helps leading academic medical centers, integrated delivery networks, children’s hospitals and healthcare service organizations achieve transformative results. Chartis has offices in Atlanta, Boston, Chicago, New York, Minneapolis, Portland and San Francisco. For more information, visit http://www.chartis.com.

Contact:
Jim Brown
National Marketing Director
The Chartis Group
jbrown(at)chartis(dot)com
+1 312 932 3051

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