Bright Spots in Care Management In Medicare Advantage

A Joint Report by Better Medicare Alliance and the Robert Graham Center

Robert Graham Center

A Fragmented System

Executive Summary

Care fragmentation is a consistent characteristic of the U.S. health care system. On average, Medicare patients see seven physicians at four practices. A staggering 75% of hospitalized patients are unable to identify the clinician in charge of their care. The negative impact of poor coordination can be seen in the prevalence of repeated tests and conflicting information between clinicians. Nearly 20% of Traditional Fee-For-Service (FFS) Medicare beneficiaries are re-hospitalized within 30 days of discharge, and half of those patients failed to see their primary care provider (PCP) in
the interim. 

Fragmentation burdens providers as well, with the average primary care physician interacting with 229 physicians at 117 different practices for Medicare patients. A 2012 National Academy of Medicine (NAM) report concluded that care delivery fragmentation leads to coordination and communication challenges for patients and clinicians and estimated that $765 billion of health care spending is wasted, or leads to little improvement
in health or in quality. The authors estimated that $130 billion of waste is attributable to inefficiently delivered services.

One strategy to achieve cost savings and improvements in quality care is care management. The Agency for Healthcare Research & Quality (AHRQ) defines care management as a team-based, patient-centered approach designed to assist patients and their support systems in managing medical conditions more effectively. Despite its growing popularity, the evidence supporting care management is mixed with one large demonstration failing to generate savings. Proponents of care management point to wide variation among programs. This report reviews the research and features that are prevalent among successful practices that function within the framework of Medicare Advantage.