Confronting the Barriers to Chronic Care Management in Medicare

April 2002
The paper attempts to show that there is a current mismatch between the chronic care related needs of the majority of Medicare beneficiaries and the historical structure of the Medicare program that is grounded in a model of indemnity insurance. Although the more innovative changes in the program would involve moving toward organizational accountability for caring for beneficiaries with chronic conditions, through capitated payments—either for all covered services or for the services specifically related to care coordination activities—such changes will depend upon results of demonstrations, some of which have recently been initiated. In the meantime, there may be an opportunity to make incremental changes within the structure of the current program that would better recognize the needs of beneficiaries with multiple chronic conditions.