As a Medicare Advantage plan that also provides medical care to its members, CareMore partners with primary care physicians to identify and refer high-risk patients who would benefit from support at its Care Centers, where multidisciplinary care teams manage patients’ needs holistically and oversee acute care.
By spending more to anticipate and address the medical challenges its frail and chronically ill members will face, CareMore aims to prevent and slow the progression of disease rather than treat its complications. In 2015, CareMore members had 20% fewer hospital admissions, 23% fewer bed days, and a 4% shorter length-of-stay than beneficiaries covered under fee-for-service Medicare. A comparative analysis of Medicare Advantage plan pricing for beneficiaries in average health indicates CareMore is more efficient in providing standard Medicare benefits than market competitors on average. Read more
In 2012, Massachusetts established a Health Policy Commission to lead collective efforts to make health care more affordable for its residents. The commission sets a statewide spending growth target and monitors payer and provider performance against it; investigates and reports on what’s driving the total cost of care; and issues data-driven policy reform recommendations.
This case study examines the origins, functions, and influence of Massachusetts’ experiment, providing lessons and insights for other states seeking new ways of controlling health costs. By engaging stakeholders in a shared cost-containment agenda, the Health Policy Commission has played a central role in coordinating a cross-sectoral effort to build a more efficient health care system in the state. Read more
Health Share is a nonprofit founded in 2012 to coordinate the provision of medical, dental, and behavioral health care for Medicaid beneficiaries in a tricounty region encompassing Portland, Oregon. It is one of 16 coordinated care organizations designated by the state to oversee and improve the delivery of these services for a geographically defined population.
Health Share distributes per-capita payments to health plans and county-run mental health agencies that have agreed to accept risk for providing or ensuring access to defined services. These risk-bearing entities collaborate with community-based organizations to improve care for high-need, high-cost patients; achieve efficiencies by centralizing certain administrative and enrollment functions; and create accountability for performance. Read more
NOTE: These case studies were conducted under a contract with the Commonwealth Fund. The views expressed are the authors and do not necessarily reflect the views of the Commonwealth Fund or its officers, directors, or staff.