BPC Report: Challenges & Opportunities in Caring for Chronically Ill Medicare Patients in Health, Report

In case you missed it, BPC published a new paper on caring for high-need, high-cost Medicare patients and recommends that Medicare Advantage plans and alternative payment model providers have more flexibility in service provision to improve and maintain patients’ health and functional status.

To highlight a couple of the paper’s action items for Congress:

– Make adjustments to the so-called “uniform benefit” rules that prohibit Medicare Advantage (MA) plans from targeting supplemental benefits, like non-emergent transportation or in-home meal delivery, to specific subpopulations of enrolled beneficiaries.

– Provide clarity to ACOs and patient-centered medical home providers to ensure that these provider organizations will not trigger violations of Medicare anti-fraud and program integrity rules when furnishing non-Medicare-covered supports at no charge for high-need Medicare patients.

Please let us know if you are interested in learning more!

Medicare Payment Should Promote Evidence-Based Care for Chronically Ill Patients

Washington, D.C.– Traditional Medicare fee-for-service reimbursement does not promote evidence-based, patient-centered care for patients with multiple chronic conditions such as diabetes and heart disease. That’s the message of a new paper by the Bipartisan Policy Center that identifies federal laws and regulations that inhibit the integration of care, and seeks input from health care providers, policymakers, and other experts on solutions to address these problems.

“Even alternative payment models, such as managed care, which are designed to promote better outcomes at a lower cost, include barriers to integrating clinical health services with other services and supports,” said Katherine Hayes, BPC health policy director. “These services have proven to reduce emergency visits, lower hospital readmissions, and help keep frail elderly individuals at home.”

Research shows that providing frail elderly patients with much needed health-related social supports, which are not covered under the traditional Medicare benefit, can improve care for patients and their caregivers, improve health outcomes, and in some cases, lower costs. In 2010, seniors with six or more chronic conditions cost Medicare more than thirty thousand dollars per person on average—roughly three times the overall average per person Medicare spending for the year. If these seniors also have functional or cognitive impairments, their Medicare costs are even greater.

BPC’s paper, “Challenges and Opportunities in Caring for High-Need, High-Cost Medicare Patients,” explores the main barriers and policy issues that prevent health plans and providers from furnishing and financing health-related interventions and social supports. These services can include: in-home meal delivery, home modifications, transportation to doctor’s appointments, targeted care management, and personal care services or other home or community-based assistive services. A final report with recommendations will be released later this year.

Hayes added, “Medicare Advantage plans and alternative payment model providers, such as accountable care organizations, must be given greater flexibility to determine how best to manage care delivery. This flexibility should be balanced by strong quality measurement standards to ensure that optimal care is being delivered. Ensuring better integration of non-Medicare covered health-related supports and services must be a top priority as we create new care delivery approaches.”

BPC’s work is supported by a grant from The SCAN Foundation and The Commonwealth Fund.

Read the full report