Targeting the High-Risk: A Consulting Group with a Mission
Frail and chronically-ill Medicare and Medicaid beneficiaries
represent US health care's highest-cost and fastest-growing service
group. The Center for Medicare and Medicaid Services reported in
2012 that dual-eligible beneficiaries were more likely to have
multiple chronic conditions (Chartbook on Chronic Conditions Among Medicare
Beneficiaries*). CMS found just 14% of beneficiaries with 6 or
more chronic conditions accounted for 55% of total Medicare
spending on hospitalizations.
Fragmented acute and long-term care methods and multiple and
conflicting oversight structures create beneficiary confusion,
establish unnecessaryaccess barriers, lead to preventable medical
complications and needlessly raise costs. Consumer satisfaction and
meaningful quality improvement and cost control are dependent upon
eliminating "system failure" in serving high-risk beneficiaries.
Health care delivery, financing and administration must be
realigned in relation to a host of interdependent care needs to
simplify access, empower patients and family caregivers, and ensure
efficient and effective provision of high-quality services.
The National Health Policy Group (NHPG) was founded to change
these unacceptable conditions and to improve payment, policy and
oversight structures to better meet the needs and improve the
situation facing our most vulnerable, frailest and special needs
SNPs will become the vehicle of choice for serving frail,
disabled, and other Medicare and Medicaid beneficiaries with
complex care needs.
Clinical interventions will be designed to serve the whole
person and recognize the volatile, co-morbid, interdependence and
ongoing nature of complex chronic conditions as a persons care
needs evolve over time and across care settings.
Medicare and Medicaid payment and oversight will recognize the
dynamic, multidimensional, collaborative and continuous nature of
care for frail elders, adults with disabilities and other persons
with severe or disabling chronic conditions.
SNPs will demonstrate better total cost and quality
performance in serving high-risk groups than for other mainstream
managed care and fee-for-service options.
Fee-for-service financing and policy impedes the ability of
plans and providers to effectively address the multidimensional,
ongoing and interrelated care needs of frail elders, adults with
disabilities and other persons with complex chronic
Pre-paid, integrated, specialized care is the preferred
approach to serving high-risk beneficiaries with the potential for
better quality, cost and satisfaction performance.
The SNP provisions in the Medicare Modernization Act of 2003
provide a platform to develop new and improved methods of care
management and delivery.
Further changes in policy, financing and practice are needed
to improve total quality and cost outcomes and ensure for the
long-term viability of Special Needs Plans.
Changing Policy and Practices to Help
NHPG is a national health policy and consulting group
established to help improve policy and practice in care of
high-risk beneficiaries including the dually eligible, frail
elders, adults with disabilities and others with serious chronic
conditions. Clients include Medicare and Medicaid plans, providers,
health systems, the public sector and national associations.
NHPG services include:
- Strategic visioning and planning
- Change-based leadership
- Coalition development and management
- Legislative and regulatory analysis
- Public policy development and advocacy
Managing the SNP Alliance
In early 2003, NHPG founded and began management of the SNP
Alliance, a coalition of leading plans and providers serving
special needs beneficiaries. Our mission is to improve the
long-term business viability of Special Needs Plans. SNP Alliance
members are strongly committed to enhancing total cost
and quality performance for high-risk populations.