The management of high cost or complex condition members is a vital component of a successful Care
Management program. These members make up a disproportionate level of costs, and losses, to
Medicare Advantage Organizations (MAOs). On average, the costs associated with high-cost members
are more than three times greater than the risk-adjusted revenue received from the Centers for Medicare
and Medicaid Services (CMS). Investment into the management of these patients will have an out-sized
impact on member experience and total plan financial performance.
