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If you want to stay updated about this program, send an email to: MAComplexCare@ihi.org

Impacting Outcomes and Costs for Complex Patients

Overview

More than one-third of enrollees in Medicare Advantage (MA) plans have chronic health needs and functional limitations that are best addressed through a combination of medical care and social services.

MA plans offer a unique opportunity to focus on high-value care for the most complex enrollees by implementing care model changes and community partnerships to address the multidimensional needs of this population. Recently, the Centers for Medicare and Medicaid Services (CMS) announced that MA plans would have greater flexibility in meeting those needs by providing new supplemental benefits to the chronically ill and expanding telehealth services.

In response to these changes, the Institute for Healthcare Improvement (IHI) is inviting MA plans to join one of two six-month Learning and Action Communities to develop or improve benefit offerings for members.

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What We Aim to Achieve

The MA Complex Care Learning and Action Community seeks to improve health outcomes for patients with complex needs while reducing the cost of care. MA plans will work in collaboration with provider organizations to develop or refine benefits that are high value, operationally simple, and designed to drive maximum member participation and impact.

Each six-month cohort will focus on one area of strategic interest to the participating MA health plans (for example, food security or transportation, remote monitoring for chronic conditions, or opportunities for telehealth).

The network will leverage IHI's expertise in health care improvement and history as a neutral convener, connecting MA plans to tactics that have been shown to make and sustain change.

Who Should Join?

MA plans seeking to improve the health of and reduce costs for complex care beneficiaries by using quality improvement methods and tools are invited to join. The first six-month program begins in November 2019, with a second starting in May 2020. MA plans can sign up for one or both Learning and Action Communities. Participating MA plans will each designate a lead participant and team.

What Participants Can Expect

IHI will help MA plans prioritize where to work based on local data and offer learning experiences focused on practical ways organizations are putting improvements into practice. Participants can pose questions and learn from MA plans successful in the topic area, IHI improvement experts, and peers through learning community activities:

  • In-person kick-off meeting
  • Two one-on-one coaching calls between the plan team and topic and improvement experts
  • Monthly all-plan calls on critical quality improvement and benefit-specific topics
  • Virtual group coaching sessions led by quality improvement and topic experts
  • Small-scale, rapid testing for learning
  • Anonymized data collection to allow potential analysis that would otherwise be impossible for any individual plan