Fact Sheet

Bright Spots in Care Management in Medicare Advantage

The Robert Graham Center for Policy Studies recently partnered with BMA to put out a publication, "Bright Spots in Care Management." You can read the full report here, or download BMA's one-pager, summarizing the report. 

Recommendations for Policymakers

  • Further evaluation and testing of models based on the blueprint presented in this report.
  • Evaluation of differences in outcomes and cost between plans and provider organizations that use care management.
  • Expansion of provider contracts in value-based, risk assumption models that include care management.
  • Incentives for the use of risk stratification to identify high need, high risk patients.
  • Incentives for the use of care management teams that include appropriate personnel, including a registered nurse, social worker and/or a community health worker working closely with clinical staff.
  • Align different payment systems and benefits for dually eligible individuals and patients with multiple chronic conditions through the use of value-based capitated payment.
  • Provide flexibility in payment and coverage to enable providers to treat patients at the most appropriate site of care and to offer additional benefits as needed to meet care goals.