OUR WORK
FEATURED CASE STUDY
Needs of Medicare Beneficiaries with Mental Health Conditions
Analysis of social determinants of health, clinical and functional need, and economic vulnerability among Medicare beneficiaries with serious mental illness and mental health conditions.
Needs of Medicare Beneficiaries with Mental Health Conditions
Our WorkNeeds of Medicare Beneficiaries with Mental Health Conditions THE ISSUE A third of Medicare beneficiaries experience a mental health condition. While providing access to high-quality behavioral health care is critical for meeting the needs of the growing...
Senior Living Communities: Uniquely Positioned to Reduce Social Isolation and Promote Social Connection in Older Adults
Our WorkSenior Living Communities: Uniquely Positioned to Reduce Social Isolation and Promote Social Connection in Older Adults THE ISSUE Social isolation among older adults can drive negative health outcomes ranging from depression, and anxiety to decreased cognitive...
State Strategies to Increase HCBS Provider Capacity
Our WorkState Strategies to Increase HCBS Provider Capacity THE ISSUE Home- and community-based services (HCBS) allow people with significant physical and cognitive limitations, many of whom are dual eligible individuals, to live well and independently in the...
A Profile of Medicare-Medicaid Dual Beneficiaries
Our WorkA Profile of Medicare-Medicaid Dual Beneficiaries THE ISSUE The approximately 12 million “dual beneficiaries” enrolled in both Medicare and Medicaid comprise a medically, functionally, and socially complex population. These individuals are often forced to...
Access to Capital in the Nursing Home Industry: A Resource on the Role of Policy and Implications for the Future
Our WorkAccess to Capital in the Nursing Home Industry: A Resource on the Role of Policy and Implications for the Future THE issue The COVID-19 pandemic reminded policymakers of the weaknesses in the United States’ long-term care system, including its workforce...
Advancing Medicare-Medicaid Integration through Medicaid Programs: A Policy Roadmap
Our WorkAdvancing Medicare-Medicaid Integration through Medicaid Programs: A Policy Roadmap THE ISSUE Approximately 12 million individuals are dually eligible for both Medicare and Medicaid. These dual eligible individuals experience medical, functional, and social...
CalAIM Community Supports: Promoting Independent Living Among Older Adults and People with Disabilities
Our WorkCalAIM Community Supports: Promoting Independent Living Among Older Adults and People with Disabilities THE OPPORTUNITY Launched January 1, 2022, the California Advancing and Innovating Medi-Cal (CalAIM) initiative affords Medi-Cal managed care plans (MCPs)...
Medicare Advantage Outperforms Fee-for-Service Medicare on Cost Protections for Low-Income and Diverse Populations
Our WorkMedicare Advantage Outperforms Fee-for-Service Medicare on Cost Protections for Low-Income and Diverse Populations THE ISSUE Of the growing number of Medicare beneficiaries, 43 percent – 28.7 million – are served by Medicare Advantage plans. As this growth...
Long-Term Acute Care (LTAC) Hospitals as Part of the Value-Based Solution: A Case Study of LTAC Hospitals in Las Vegas
Our WorkLong-Term Acute Care (LTAC) Hospitals as Part of the Value-Based Solution: A Case Study of LTAC Hospitals in Las Vegas THE ISSUE Long-term acute care (LTAC) hospitals specialize in providing treatment for patients with complex medical conditions who require...
Quantifying Dual Eligible Beneficiaries in Medicaid MLTSS and FFS Medicare
Our Work Quantifying Dual Eligible Beneficiaries in Medicaid MLTSS and FFS Medicare THE ISSUE Dual-eligible beneficiaries often must navigate two uncoordinated, complex programs: Medicare and Medicaid. This lack of coordination creates barriers to access, poor health...
Profile of the California Medicare Population
Our WorkProfile of the California Medicare Population THE ISSUE Understanding the characteristics of California’s growing Medicare population is important for the state and its stakeholders to understand the needs of these beneficiaries and identify opportunities to...
The Spectrum of State Models to Support Medicaid LTSS
Our WorkThe Spectrum of State Models to Support Medicaid LTSS THE ISSUE Medicaid Long-Term Services and Supports (LTSS) are provided to only 6% of Medicaid beneficiaries but account for a disproportionate 33% of total Medicaid spend. In anticipation of demographic...
Enhancing Medicare-Medicaid Integration: Bringing Elements of the FAI into D-SNPs
Our WorkEnhancing Medicare-Medicaid Integration: Bringing Elements of the Financial Alignment Initiative into Dual-Eligible Special Needs Plans THE ISSUE Individuals dually eligible for Medicare and Medicaid typically must navigate a fragmented and sometime...
Access to Medicare-Medicaid Integrated Products
Our WorkAccess to Medicare-Medicaid Products THE ISSUE Dual eligible individuals represent a medically, socially, and often functionally complex population. They tend to be low-income with high-risk for socioeconomic disadvantage and use more healthcare services than...
Modernizing California’s HICAP: Strategy Recommendations
Our WorkModernizing California's HICAP: Strategy Recommendations THE ISSUE State Health Insurance Assistance Programs (SHIPs) provide valuable counseling services to Medicare beneficiaries across the country. Each state program varies in its design and operations. The...
Role of Inpatient Rehabilitation Hospitals During the COVID-19 Pandemic
Our WorkRole of Inpatient Rehabilitation Hospitals During the COVID-19 Pandemic THE ISSUE Short-term acute care hospitals (STACHs), which typically discharge more than 40% of their Medicare FFS patients to post-acute care, have faced enormous pressures in managing not...
Dual Eligible Beneficiaries Receive Better Access to Care and Cost Protections when Enrolled in Medicare Advantage
Our WorkDual Eligible Beneficiaries Receive Better Access to Care and Cost Protections when Enrolled in Medicare Advantage THE ISSUE Those enrolled in Medicare and Medicaid, called “dual eligibles,” have the highest spending and most complex medical, functional, and...
Independent and Assisted Living: Complex Populations Deserving Integrated Housing, Clinical, and Lifestyle Support
Our WorkIndependent and Assisted Living: Complex Populations Deserving Integrated Housing, Clinical, and Lifestyle Support THE ISSUE 1.6 million Medicare beneficiaries live in independent or assisted living communities nationwide. The complex care needs of these...
Advancing Non-Medical Supplemental Benefits in Medicare Advantage
Our WorkAdvancing Non-Medical Supplemental Benefits in Medicare Advantage First available in 2019 and 2020, Medicare Advantage (MA) non-medical supplemental benefits provide an unprecedented opportunity to deliver valuable non-medical services to Medicare...
Expanding Long-Term Care Pharmacy in Home and Community-based Settings: Understanding and addressing the barriers
Our WorkExpanding long-term care pharmacy in home and community-based settings: understanding and addressing the barriers THE ISSUE LTC pharmacy includes high-touch coordination, patient and caregiver education supports, and other services important to individuals...
Medicare Advantage Sees Fewer COVID-19 Hospitalizations in Beneficiaries and Offers Greater Access to In-Person and Telehealth Non-COVID Care During Pandemic
Our WorkMedicare Advantage Sees Fewer COVID-19 Hospitalizations in Beneficiaries and Offers Greater Access to In-person and Telehealth Non-COVID Care During Pandemic THE ISSUE As COVID-19 variants lead to new waves of infections, conversations about engaging in...
Implementing an Integrated Long-Term Services and Supports Buy-in Program: A Cost Estimate
Our WorkImplementing an Integrated Long-Term Services and Supports Buy-in Program: A Cost Estimate THE ISSUE As the nation continues to age, the need for long-term services and supports (LTSS) will grow; however, access is limited. Public coverage of LTSS is primarily...
A Brief Overview of Key Beneficiary Protections in Medicare-Medicaid-Integrated Programs
Our WorkA Brief Overview of Key Beneficiary protections in Medicare-Medicaid Integrated Programs THE ISSUE Dual eligible beneficiaries, who are enrolled in both Medicare and Medicaid, typically experience fragmented and misaligned care between the two uncoordinated...
Understanding the Long-Term Care Needs of the Medicare Population and the Role of Long-Term Care Pharmacies in Addressing this Need
Our WorkUnderstanding the Long-Term Care Needs of the Medicare Population and the Role of Long-Term Care Pharmacies in Addressing this Need THE ISSUE As many as 70 percent of individuals who reach age 65 will experience severe long-term care (LTC) needs before they...
Medicare Advantage Offers High Quality Care And Cost Protections To Racially And Ethnically Diverse Beneficiaries
Our WorkMedicare Advantage Offers High Quality Care And Cost Protections To Racially And Ethnically Diverse Beneficiaries THE ISSUE The COVID-19 pandemic has exposed longstanding inequities and vulnerabilities experienced by racially and ethnically diverse...
Assisted Living: An Important Option for Providing LTSS in the Community
Our Workassisted living: an important option for providing ltss in the community THE ISSUE For many older adults, aging is accompanied by cognitive and/or physical decline that requires caregiving supports for everyday activities like bathing, dressing, meal...
Advancing the Policy Environment to Address the Unique Needs of Partial Dual Eligible Beneficiaries
Our Workadvancing the policy environment to address the unique needs of partial dual eligible beneficiaries THE ISSUE While recent policy attention and innovation has been directed at “dual eligible” beneficiaries who qualify for both Medicare and Medicaid,...
Opportunities for States and Health Plans to Improve Access to Home and Community-based Services
Our WorkOPPORTUNITIES FOR STATES AND HEALTH PLANS TO IMPROVE ACCESS TO MEDICAID HOME AND COMMUNITY-BASED SERVICES THE ISSUE The population of Americans needing long-term services and supports (LTSS) continues to grow, with estimates suggesting that as many as...
Medicare Advantage Outperforms Traditional Medicare on Cost Protections for Medicare Beneficiaries
Our WorkMEDICARE ADVANTAGE OUTPERFORMS TRADITIONAL MEDICARE ON COST PROTECTIONS FOR MEDICARE BENEFICIARIES A COVERAGE OPTION THAT REDUCES BENEFICIARY SPENDING WHILE PRESERVING SATISFACTION WITH QUALITY AND ACCESS TO CARE THE ISSUE Medicare Advantage and Traditional...
A Blueprint for Reforming Medicaid Long-Term Services and Supports and Creating Good Caregiving Jobs
Our WorkA Blueprint for Reforming Medicaid Long-Term Services and Supports and Creating Good Caregiving JobsTHE ISSUE For many Americans, everyday activities such as driving, bathing, and cooking can be incredibly difficult due to complex medical and functional needs....
Role of LTAC Hospitals in COVID-19 Pandemic
Our WorkRole of LTAC Hospitals in COVID-19 Pandemic THE ISSUE The ongoing COVID-19 pandemic has significantly disrupted all acute and post-acute care delivery in a manner that may permanently change hospital discharge patterns and provider roles moving forward....
Special Supplemental Benefits for the Chronically Ill in Plan Year 2021
Our WorkSpecial Supplemental Benefits for the Chronically Ill in Plan Year 2021 THE ISSUE Congress recently introduced new flexibility to allow plans to offer expanded supplemental benefits for chronically ill beneficiaries, known as Special Supplemental Benefits for...
Significant Financial Benefits Locked in LTCi Policies In Force Today
Our WorkSignificant Financial Benefits Locked in LTCi Policies In Force Today Why State Support for the Long-Term Care Insurance Industry Makes Good Financial Sense THE ISSUE Our nation’s long-term care system relies heavily on personal savings and Medicaid to fund...
Medicare Beneficiaries Who Are Most Unlikely to Get a Flu Shot
Our WorkMedicare Beneficiaries Who Are Most Unlikely to Get a Flu Shot THE ISSUE As the pandemic continues and routine healthcare utilization declines, many older adults are forgoing critical, preventive services. One of the most important preventive services...
New Primarily Health-Related Benefits in 2021 Medicare Advantage Plans
Our WorkNew Primarily Health-Related Benefits in 2021 Medicare Advantage Plans THE ISSUE Medicare has long limited the types of benefits that could be reimbursed in Medicare Advantage to only medical and primarily health-related services. Recently, however, the...
Social Risk Factors Are High Among Low-Income Medicare Beneficiaries Enrolled in Medicare Advantage
Our WorkSocial Risk Factors Are High Among Low-Income Medicare Beneficiaries Enrolled in Medicare Advantage Medicare Advantage beneficiaries are Likely to experience social risk factors that negatively impact health THE ISSUE Research has found that social...
Telehealth During a Time of Crisis: Medicare Experiences Amid COVID-19
Our WorkTelehealth During a Time of Crisis: Medicare Experiences Amid COVID-19 THE ISSUE The COVID-19 public health emergency (PHE) has challenged health care payers and providers to address new and urgent demands, creating misalignment in supply, demand, and...
Considerations for Balancing Seniors Housing Residents’ Safety as Communities Reopen
Our WorkConsiderations for Balancing Seniors Housing Residents’ Safety as Communities Reopen A Strategic Approach to the COVID-19 Pandemic THE ISSUE Seniors housing operators face unparalleled challenges in our shared COVID-19 related public health crisis. With safety...
Protecting Consumers and Medicaid from Catastrophic Long-Term Care Costs
Our WorkProtecting consumers and medicaid from catastrophic long-term care costs How financial challenges in the long-term care industry may shift costs to policyholders and medicaid THE ISSUE Long-term care insurance (LTCi) is a financial product that promises over 7...
Medicare Advantage Provides Strong Financial Value to Beneficiaries as Compared to All Other Coverage Options
Our WorkMedicare advantage provides strong financial value to beneficiaries As compared to all other coverage options an important option for innovative, affordable access to care THE ISSUE Medicare beneficiaries have access to numerous coverage configurations...
Meeting Medicare Beneficiary Needs During COVID-19
Our WorkMeeting medicare beneficiary needs during covid-19 Using Medicare Advantage supplemental benefits to respond to the pandemic THE ISSUE The COVID-19 pandemic is placing an extraordinary toll on the healthcare system and restricting Medicare beneficiaries to...
An Idea That’s Growing
Our WorkAn Idea That's Growing Long-Term Care Providers Taking Charge in Managed Care THE ISSUE While traditional insurance companies sponsor most Medicare Advantage (MA) plans, a growing number of hospitals, health systems, and physician groups also offer this...
POST-ACUTE PREPAREDNESS IN A COVID-19 WORLD
Our WorkPOST-ACUTE PREPAREDNESS IN A COVID-19 WORLD A FRAMEWORK FOR POST-ACUTE CARE RECOVERY AND REDESIGN THE ISSUE The supply of care provided after a hospital stay – commonly referred to as “post-acute care” – has also been disrupted by the pandemic. Under normal...
SPECIAL SUPPLEMENTAL BENEFITS FOR THE CHRONICALLY ILL (SSBCI) AND NEW PRIMARILY HEALTH RELATED BENEFITS
Our WorkSPECIAL SUPPLEMENTAL BENEFITS FOR THE CHRONICALLY ILL (SSBCI) AND NEW PRIMARILY HEALTH RELATED BENEFITS MEDICARE ADVANTAGE SSBCI AND NEW PRIMARILY HEALTH-RELATED SUPPLEMENTAL BENEFITS LANDSCAPE THE ISSUE Medicare Advantage plans can now offer a wide...
HEALTHCARE SERVICES IN SENIOR LIVING AND NURSING HOMES
Our WorkHEALTHCARE SERVICES IN SENIOR LIVING AND NURSING HOMES THE CASE FOR INTEGRATION THE ISSUE Residents of senior living and nursing home facilities have substantial health needs and use a great deal of high-cost healthcare services. At the same time, many...
A TURNING POINT IN MEDICARE POLICY
Our WorkA Turning Point in Medicare Policy Guiding Principles for New Flexibility Under Special Supplemental Benefits for the Chronically Ill THE ISSUE The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, signed into law on...
INVENTION BORN OF NECESSITY: THE PROVIDER-LED MEDICARE ADVANTAGE PLAN
Our WorkINVENTION BORN OF NECESSITY: THE PROVIDER-LED MEDICARE ADVANTAGE PLAN EVALUATING AN ORGANIZATION’S ABILITY TO PROVIDE INSURANCE TO ITS RESIDENTS THE ISSUE In today’s changing environment, post-acute and long-term care providers face big challenges—increasing...
CHRONIC CARE ACT: MAKING THE CASE FOR NON-MEDICAL SERVICES AND SUPPORTS IN MEDICARE ADVANTAGE SUPPLEMENTAL BENEFITS
Our WorkCHRONIC CARE ACT: MAKING THE CASE FOR NON-MEDICAL SERVICES AND SUPPORTS IN MEDICARE ADVANTAGE SUPPLEMENTAL BENEFITS ANALYZING DATA TO HELP PLANS IDENTIFY TARGET POPULATION FOR BENEFITS THE ISSUE With new flexibility in Medicare Advantage (MA) supplemental...
COMPARING THE CHARACTERISTICS AND EXPERIENCES OF MEDICARE BENEFICIARIES
Our WorkCOMPARING THE CHARACTERISTICS AND EXPERIENCES OF MEDICARE BENEFICIARIES ANALYZING DATA TO PREPARE FOR GROWING NUMBER OF HIGH-NEED MEDICARE BENEFICIARIES THE ISSUE Starting in 2020, the United States will experience extraordinary growth in the 75+ population....
THE HOT SPOT FOR MEDICARE SPENDING
Our WorkFUNCTIONAL IMPAIRMENT A KEY FACTOR IN HIGH MEDICAL SPENDING IDENTIFYING THE KEY SPENDING DRIVERS IN MEDICARE POPULATION THE ISSUE The discourse on major drivers of high medical spending for American seniors often focuses on the role of chronic conditions but...
BIPARTISAN CONSENSUS IN LONG-TERM CARE FINANCING
Our WorkBIPARTISAN CONSENSUS IN LONG-TERM CARE FINANCING EMERGING CONSENSUS ON A CHALLENGING PUBLIC POLICY PROBLEM THE ISSUE Half of all Americans turning 65 today will one day find themselves needing a high level of help with basic daily activities, such as walking,...
KEY COMPONENTS FOR SUCCESSFUL LTSS INTEGRATION
Our WorkKEY COMPONENTS FOR SUCCESSFUL LTSS INTEGRATION DEVELOPING THE BUSINESS CASE FOR LTSS INTEGRATION THE ISSUE A small share of the population with the most complex care needs accounts for a large portion of all healthcare spending. Healthcare payment and delivery...
REDUCING HOSPITALIZATIONS BY INTEGRATING HEALTH AND HOUSING
Our WorkREDUCING HOSPITALIZATIONS BY INTEGRATING HEALTH AND HOUSING QUANTIFYING THE VALUE OF HEALTHCARE INVESTMENTS BY SENIOR HOUSING OPERATORS THE ISSUE Over the next 15 years, 80 percent of the United States population will experience one or more chronic conditions,...
MEDICARE SPENDING ON OLDER ADULTS WHO NEED LONG-TERM SERVICES AND SUPPORTS
Our WorkMEDICARE SPENDING ON OLDER ADULTS WHO NEED LONG-TERM SERVICES AND SUPPORTS ESTABLISHING THE VALUE IN ADDRESSING NEEDS OF LTSS POPULATION THE ISSUE Experts may have overlooked a critical factor in understanding high Medicare spending and defining the high-cost,...