Financing Medicare Managed Care
The majority (about 85%) of older adults enrolled in Medicare managed care are
enrolled in a (HMO), which may also be referred to as a Managed Care Organization (MCO).
Within the evolving Medicare HMO delivery system there is the opportunity to develop a team
approach, which includes social work for the care of high-risk older adults.
The implications for systems receiving capitation for Medicare managed care
members include:
- The need for an effective system to identify and triage high risk and frail
elderly patients so that such patients receive appropriate care and the financial
risk to the physician is minimized.
- The need to look at the patient’s medical, social, functional and mental health needs in developing and
implementing a care plan.
- The need to follow the patient across a continuum of health care settings, to
ensure that care is appropriate and cost-effective.
- The need to maximize resources, by using ancillary providers, case management,
and community services.