High Risk Screening and Geriatric Care Management

Medicare HMOs are required by HCFA to conduct a risk screening on all new members within the first 90 days of enrollment. This risk screening allows the Medicare HMO to identify and risk stratify the new members, and should provide the following information:

  1. Identifies members at high risk for medical complications

  2. Identifies members likely to be high users of health care service

  3. Targets patients with certain diseases (such as diabetes) or chronic conditions - for education, early intervention, and/or caregiver support

  4. Identifies patients who will benefit from case management services

  5. Provides physicians with baseline information on their patients TEAMS00000004.gif.

The results of the screening and risk stratification of new members should be provided by the health plan to the primary care physician. This information is of critical importance in identifying the medically complex and high-risk older adults who could benefit from geriatric care management.

"In the field of geriatrics, team delivery of comprehensive care has resulted in lower mortality, fewer hospitalizations and reductions in length of stay, more home discharges, fewer drug prescriptions, greater satisfaction on the part of patients and caretakers, less commitment to and time in nursing homes, improved morale and functional status and lower direct costs."TEAMS00000004.gif

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