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New Medicare Recommendations Could Improve the Health of Chronically Ill Patients

Washington, D.C.– A new report by the Bipartisan Policy Center offers recommendations to Congress and the administration on ways to help health plans and providers improve care for people with chronic illnesses. Critical evidence suggests that these patients could greatly benefit from interventions such as in-home meal delivery, home modifications, targeted care management services, and non-emergency transportation to medical appointments. However, current Medicare payment rules and regulations prevent plans and providers from funding these types of social supports and integrating them into care models, despite promising results shown in other programs.

“Research shows that providing frail elderly patients these services can reduce emergency visits, lower hospital readmissions, and help improve the overall health of these chronically ill individuals,” Katherine Hayes, BPC health policy director. “Incorporating these services, which are not covered under the traditional Medicare benefit, into a patient’s care plan can help improve their health outcomes, and in some cases, lower their medical costs.”

The report, Improving Care for High-Need, High-Cost Medicare Patients, also provides new data indicating that there are an estimated 3.65 million Medicare beneficiaries who live in community settings and have three or more chronic conditions and functional or cognitive impairment. Annually, these patients incur roughly $30,000 in Medicare expenses. This is more than double the average Medicare patient.

Our recommendations give plans and providers the flexibility they need to determine how best to manage care delivery for our nation’s most chronically ill patients.

BPC offers several recommendations that would allow health plans and providers to give these services and supports to chronically ill Medicare patients (who are not eligible for full Medicaid benefits) including:

  • Reforming Medicare Advantage supplemental benefit rules to allow frail and chronically ill enrollees to receive targeted non-medical services and supports.
  • Changing Medicare’s risk adjustment model to remove the financial disincentive for caring for functionally impaired patients. ·
  • Developing new quality measures that will financially incentivize Medical Advantage plans and Accountable Care Organizations to provide non-Medicare-covered social supports.
  • Clarifying anti-fraud rules to allow Accountable Care Organizations and medical homes to provide non-Medicare-covered supports to chronically ill patients for free.

Hayes added, “Our recommendations give plans and providers the flexibility they need to determine how best to manage care delivery for our nation’s most chronically ill patients without adding new costs to the Medicare program. Ensuring better integration of non-Medicare covered health-related supports and services must be a top priority as we create new care delivery approaches.”

Many of BPC’s recommendations are similar and complementary to those in the Chronic Care Act of 2017, which was drafted by a bipartisan Chronic Care Working Group and is now pending before the Senate Finance Committee.