United States: Senate Workgroup's Proposals Address Chronic Illness Through Medicare

Last Updated: January 12 2016
Article by Kush Das

The Senate Finance Committee chronic care working group recently released a Policy Options Document continuing an effort that started with a hearing titled, "Chronic Illness: Addressing Patients' Unmet Needs" in the summer of 2014. The workgroup, which is led by Chairman Orrin Hatch, Ranking Member Ron Wyden, and Senators Johnny Isakson and Mark Warner, compiled proposals and feedback from industry stakeholders, the Centers for Medicare & Medicaid Services (CMS), and the Medicare Payment Advisory Commission (MedPAC). The bipartisan options paper outlines policies being considered to improve how Medicare treats beneficiaries with multiple, complex chronic illnesses.

When proposing the policies, the options paper is explicitly noncommittal about whether the policies will actually become legislation and notes that any proposals will have to be scored by the Congressional Budget Office (CBO) to ensure that the legislation is cost-saving or at least revenue neutral. With those caveats in mind, the workgroup sets out three policy goals:

  • Increasing care coordination among providers across the care continuum;
  • Streamlining Medicare payment systems to incentivize appropriate care levels for chronic care; and
  • Improving quality and care coordination while also becoming more efficient to cut spending.

To achieve those goals, the options paper suggests multiple policy initiatives broken into six categories and requests stakeholder comments.

Policy Proposals:

(1) Expanding Home Health Care: Nationalizing and making permanent the current Independence at Home (IAH) initiative that CMS is testing that uses physician and nurse-practitioner directed home-based primary care teams for beneficiaries with multiple chronic illnesses. The IAH initiative requires 24/7 response availability and incentivizes better performance and quality with lower annual expenditures. The paper also suggests removing restrictions from home hemodialysis treatment to better incorporate and facilitate monthly physician reviews through telehealth.

(2) Advancing Team-Based Care: Changing Medicare Advantage (MA) to include hospice care, remove restrictions on End Stage Renal Disease (ESRD) patient enrollment, and expand Special Needs Plans to cover more beneficiaries. Also, the workgroup suggests improving care management services by creating a new high-severity care management code and policies that incorporate behavioral health in Medicare fee-for-service reimbursement and Medicare Advantage.

(3) Expanding Innovation and Technology: Adapting and expanding supplemental benefits such as non-clinical services, alternative care such as acupuncture, counseling, and transportation for chronically ill MA enrollees and Accountable Care Organization (ACO) patients. Returning to a telehealth focus, the workgroup suggests incorporating telemedicine more into MA plans, removing restrictions on telehealth coverage for ACOs, and utilizing telehealth for stroke cases.

(4) Identifying Chronically Ill Populations and Improving Quality: Developing quality measures for chronic care conditions and changing the CMS-Hierarchical Condition Categories (CMS-HCC) Risk Adjustment model to consider chronic care specifically by considering patients' number of conditions, behavioral health, dual eligibility, and historical data.

(5) Empowering Individuals & Caregivers: Encouraging care management by waiving beneficiary co-payments for care management services that create an administrative burden for providers, patients, and ACOs. The workgroup also advocates for more individual- and population-focused education and coaching by establishing a billing code for one-time conversations with newly diagnosed Alzheimer/dementia patients, expanding access through pre-diabetes education by incentivizing physicians through Medicare payments, and expanding online information and educational tools for chronic diseases on government websites.

(6) Miscellaneous Policies to Improve Chronic Care: In this last category, the options paper proposes: (a) increasing transparency at the Center for Medicare and Medicaid Innovation (CMMI) by strengthening notice and comment requirements for CMMI programs; (b) studying medication synchronization of prescription drug plans in Medicare Part D to focus on coordinating and analyzing drug interactions, dispensing, and counseling; and (c) studying obesity drugs to detail utilization and impact, and analyze experiences of Medicare Part D prescription drug plans that are currently offering obesity drugs as a supplemental benefit.

For two more weeks, the working group is accepting feedback on the proposals, which can be sent to chronic_care@finance.senate.gov and will be accepted through January 26, 2016.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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