This Urban Institute Report explores ways to increase the effectiveness of chronic care delivery while also reducing costs.  It describes the various populations in need of chronic care coordination, current effectiveness evidence, various entities that can be responsible for coordinating care, and potential financing and payment options.

Evidence from Medicaid or this population requires both medical care and social supports to address limitations in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), services covered by Medicaid (for low-income beneficiaries) and some programs of the Administration on Aging not restricted by income. Since their introduction in 1981, Medicaid Home and Community-Based Services (HCBS) covered under Section 1915(c) waivers have been the source of innovative programs developed by states to serve nursing-home eligible beneficiaries who wish to remain in their own homes or other community settings. HCBS programs employ “care management” (also called “case management”) personnel to use standardized assessment tools for determining an individual’s eligibility for services, identify service needs, develop a plan of care to meet these needs, and provide ongoing monitoring to assure that appropriate care is being provided. State experience with case management and care coordination in Medicaid is a source of important insights into effective models for the broader population with multiple chronic conditions requiring both medical and social support services.

Full Report: Structuring, Financing and Paying for Effective Chronic Care Coordination (PDF | 756.63 KB)

The Urban Institute Health Policy Center. (2009). Structuring, financing and paying for effective chronic care coordination. Berenson, Robert A.; Howell, Julianne.