MEDICARE

Medicare patients are significantly different from younger populations. Medicare health plan analyses need to account for the profound impact of aging on case mix and severity. Most people will spend the majority of all of their Medicare health dollars in the last few months of life. Illness burden in senior populations can change dramatically and rapidly.

EmmData models and tools focus on matching interventions to those patients most likely to benefit from medical management. There is included support for a wide variety of intervention programs such as:

Fall Risk End of life Sign and symptom monitoring Remote telemonitoring Traditional case management Hospital readmission Discharge reconciliation Pharmacy management Condition specific management

The presence of CMS and its policies and practices has a large effect on how plans address problems. For example, a Medicare plan that reimburses inpatient hospitalization on a DRG basis is likely to be less concerned about length of stay as it is with the number of readmits. EmmData tools are customizable to account for individual plan concerns and business rules.