Trend #3: Highest Chronic Care Conditions in Medicare, Medicare Advantage Plans, And Special Needs Plans

Six Leadership Readiness Discussion Questions

Payers are developing care models specific to the level of need. For example, on multiple chronic conditions and complex needs, care for homebound patients, and end-of-life care. Or they may focus on specific conditions such as cardiology, oncology, or neurology. There is not a one-size-fits-all care-management strategy. Payers tend to categorize medical conditions by risk.

Risk Categories

For example, the highest risk would be end-of-life and specialty chronic care conditions, such as cancer. The next high risk is complex poly chronic conditions such as diabetes and depression. A rising risk would be primary care treatable conditions such as COPD or hypertension.