These and related issues will require HCFA to actively collaborate with all types of payors, health care plans, providers, research organizations, and consumer and disability groups to develop strategies and solutions that will maximize the quality of health care and other services for patients with serious and complex medical conditions.

Conclusions

The needs of patients with serious and complex medical conditions far exceed the boundaries of a single issue such as access to specialists for care. For health care delivery systems to provide high-quality, effective care for these patients, the systems must be responsive to a diverse array of clinical, social, mental, and functional health issues. The development of a health care delivery system that will provide quality and effective care for these patient populations must be responsive to a diverse group of clinical, social, mental, and functional health issues. The health care delivery system must also be capable of working effectively with other community and social support systems.

The questions raised by HCFA concerning implementation and regulations for the Medicare+Choice program apply broadly to include all health care delivery and payment systems, including fee-for-service care. This study is one of the first to address these complex and extremely important topics. Thus, the committee urges HCFA, health care plans, and consumer groups to view this report, and especially its conclusions and recommendations, as first steps in the effort to address the unique and complicated needs of persons with serious and complex medical conditions and to ensure that they receive the most cost-effective and best-quality care possible. The work of this committee is intended to support and provide direction for future work to be conducted by HCFA, in collaboration with all types of health care plans and consumer organizations, to design innovative strategies to ensure adequate reimbursement, access to broad care management, and the highest possible quality of treatment services required by patients with serious and complex medical conditions.



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