Senate Committee Working for Improved Care of Chronic Conditions

Medicare Coverage of Chronic Conditions

As Medicare beneficiaries, are you exhausted by the politics surrounding the passing of the American Healthcare Act (AHCA), aka “Trumpcare,” and repealing of the Affordable Care Act (ACA), aka “Obamacare”? There was a refreshing moment for improving healthcare today when the Senate Finance Committee held an open hearing to examine bipartisan polices that improve care for patients with chronic conditions. It came as senators, doctors, and insurance policy leaders discussed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. The future of Medicare, Medicare Advantage, and supplemental insurance programs seems a tad brighter as a result.

There will be an executive session on the Chronic Care Act this Thursday, May 18. Until then, here are some highlights from today:

U.S. Senators Focused on Improving Healthcare

After a brief review of the bill’s history, Senate Finance Committee Chairman Orrin Hatch (R-Utah) noted that several of the policies recommended by the working group have already been enacted, and that the committee is working to ensure the additional policies are signed and enacted as soon as possible. “The committee has not only learned about the burden imposed on Medicare patients living with chronic conditions, but also identified new policies to improve care coordination, increase value, and lower costs in the Medicare program without adding to the deficit,” Hatch said.
Read Senator Hatch’s full statement

Ranking Senate Finance Committee Member Ron Wyden (D-Oregon) noted the committee’s primary goal is to update the guarantee of Medicare delivering improved services to seniors who have chronic ailments. This includes a focus on healthcare services in the home to alleviate treatment in institutions, expanding life-saving technology to seniors, and focusing more on primary care. “Today, Medicare is about cancer, diabetes, heart disease, strokes, and other chronic conditions,” he said. “Seniors who have two or more of these chronic conditions account for more than 90% of Medicare spending…. In my view, still to come, is ensuring that each senior with multiple chronic conditions has an advocate to guide them through what can be a teeth-gnashing experience of navigating American healthcare.”
Read Senator Wyden’s full statement

Bipartisan Policy Supports CHRONIC Act

The first non-government official to speak at the hearing was Katherine Hayes, Director of Health Policy at the Bipartisan Policy Center (BPC). Formed in 2007, the BPC has focused on working with such stakeholders in the healthcare industry as patients, providers, policymakers, and more to promote a higher quality of care while hindering the expansion of healthcare costs in federal programs. The BPC found that chronic conditions, particularly when added to functional or cognitive impairments, is a powerful driver of the use of healthcare services for Medicare beneficiaries.

“Medicare data from 2015 demonstrate that the number of chronic conditions that a patient has is directly correlative to higher Medicare spending and rates of hospitalization- as the number of chronic conditions rise, so do average Medicare costs per beneficiary,” Hayes noted in her testimony.

She added that, when compared to Medicare recipients with fewer than four chronic conditions, beneficiaries who have four or more chronic illnesses acquire an average annual Medicare cost that is more than five times as high, have double the amount of hospital readmissions, and have four times as many visits to the emergency room.

Recommendations by the BPC to improve Medicare and health insurance coverage for patients with chronic conditions include modifying the Medicare Advantage “uniform benefit requirement” to allow plans to focus on non-Medicare covered social benefits. This would play an important role in reducing hospitalizations and, therefore, lowering overall costs.
Read Director Hayes’ full testimony

Telehealth is the Future

Speaking on behalf of the American Heart Association and American Stroke Association, Dr. Lee Schwamm of Harvard Medical School, emphasized the importance of the CHRONIC Care Act including telehealth treatment in its coverage. “We support policies that would allow Medicare Advantage plans to use additional, clinically appropriate telehealth technologies,” he said. “In fact, the American Heart Association has estimated that Medicare and Medicaid programs could save as much as $1.2 billion over 10 years, even after the costs of providing more telestroke evaluations and more [of the clot-dissolving drug Alteplase] tPA are factored in.”

Schwamm continued his emphatic support of the telehealth medicine by noting that the Medicare Payment Advisory Commission found telestroke to be one of the most cost-effective means of treating strokes in urban, suburban, and rural settings. He believes the right steps taken via the CHRONIC Care Act could actually reduce the burden of strokes as a chronic disease.
Read Dr. Schwamm’s full testimony

Special Needs Plans Need to Be Permanent

As the President of Government Programs and Individual Advantage at UPMC Health, John G. Lovelace took the opportunity in his testimony to address Medicare Special Needs Plans (SNP). He noted that, since their implementation in 2003, SNPs have expanded healthily and provide specific coverage and aid to more than 2 million people on Medicare. “The story of SNPs is one of success for both the Medicare program and the beneficiaries it serves, and… every beneficiary enrolling in the program is likely to receive better tailored and more coordinated services than he or she would otherwise have in a fee-for-service Medicare or the broader Medicare Advantage program.”

If passed, the CHRONIC Care Act would permanently authorize SNPS, which could expand additional benefits to Medicare Advantage recipients and, therefore, impact long-term expenditures in Medicare Advantage.
Read President Lovelace’s full testimony

The Need for Accountable, Value-Based Care

As the Senior Vice President for Population Health Management at Montefiore Health System, Stephen Rosenthal alluded to his experience observing care of diverse patients who come from the urban, suburban, and rural areas of New York State. While he did not mention specific policy recommendations as previous testimony did, Rosenthal did note that 5% of the 400,000 patients covered by Montefiore’s value-based contracts (which includes 55,000 Medicare recipients) accounted for 65% of total cost of care. He noted this is largely due to chronic conditions.

“I am intrigued by your propose to Accountable Care Organizations (ACOs) to offer beneficiaries incentives to obtain primary care services from its network providers,” he said. “Why not allow us to offer similar incentives to their patients? While there may be a cost to developing the infrastructure to administer the benefit, it seems to me to have the potential to be a win-win-win-win proposition. It could benefit the patient directly, both financially and in terms of improved health; the provider, by improving his or her quality scores; the ACO itself by increasing its potential for shared savings; and the Medicare program by lowering the total cost of care to the system.”
Read Senior Vice President Rosenthal’s full testimony

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