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According to CMS data, over two thirds of Medicare beneficiaries, or 21.4 million beneficiaries, had two or more chronic conditions.

Almost one in every three Medicare dollars is spent on caring for individuals with diabetes. Active and effective management of these conditions is essential to ensuring that Medicare beneficiaries receive the best possible care and that the Medicare program is sustainable.

Medicare Advantage (MA) is uniquely positioned to address chronic disease – unlike FFS, the payment model in MA encourages providers to identify, manage, and treat chronic illness in innovative ways that are cost-effective and produce high-quality outcomes.

  • MA plans are actively engaged in helping to identify and document beneficiary health conditions in order to initiate early intervention and slow disease progression.
  • MA plans emphasize preventive services and primary care. Primary care teams coordinate care for beneficiaries and work to ensure proper screening and disease management, particularly for those with chronic conditions.
  • MA plans offer services specifically designed to help beneficiaries with chronic conditions stay as healthy and active as possible. Through robust health information technology platforms and programs that coordinate care for beneficiaries who see multiple health care providers, MA works to ensure that chronically ill beneficiaries receive the most clinically appropriate care.

To ensure effective identification and treatment of beneficiaries with chronic illness, MA payments must accurately reflect the health status of MA enrollees. Accounting for the health status of beneficiaries for payment purposes is called risk adjustment and ensures MA has adequate resources to reimburse providers treating MA beneficiaries, including individuals with complex chronic diseases.

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