Who pays for the coach?
The intervention was specifically designed to be compatible within both Medicare Advantage and traditional Medicare fee-for-service payment systems. The financial incentives of capitated payment are well aligned to support an intervention designed to better integrate care across settings and reduce subsequent use of acute services such as hospitalization. The cost of the Transitions CoachTM would likely be assumed by the Medicare Advantage program. In a traditional Medicare fee-for-service payment environment, financial incentives do exist, but are less apparent. There are incentives, for example, for acute care hospitals. Many hospitals across the country are operating at capacity and frequently need to divert patients to other hospitals. Hospitals operating in these environments have a financial incentive to facilitate transfer of complex older patients for whom reimbursement is less favorable to other care settings (such as skilled nursing facilities) to create bed capacity for pati
