As discussion of how best to address the health needs of millions of Medicare beneficiaries struggling with multiple chronic illnesses receives increased attention in Congress, the Better Medicare Alliance (BMA) hosted a Congressional briefing, “The Value of Medicare Advantage: Innovations in Chronic Disease Management”, on November 18.
The event brought together key health care stakeholders to discuss how Medicare Advantage is at the forefront of developing and incentivizing innovative ways to prevent, detect, and treat complex chronic conditions.
Dr. Ken Thorpe, BMA Board member and Chairman of the Partnership to Fight Chronic Disease, gave opening remarks, followed by speeches by panelists and a lively Q & A session. The event featured a panel of health providers and policy experts who discussed innovation, progress and challenges in Medicare payment and health care delivery reform.
Jim Parker, President of Indiana University Health Plans, said Fee-For-Service (FFS) health care does not promote well coordinated, integrated care consistently.
“Certainly CMS and private payers are all interested in seeing the delivery system marketplace move towards more predictable and sustainable models,” said Parker. “Medicare Advantage reduced our inpatient admissions by 8 percent, average length of stay by 5 percent, and EMR visits by 13 percent.”
With Medicare Advantage, “our clinicians found that they could help coordinate or quarterback care more effectively with the involvement of a social worker or a behavioral therapist or a nutritionist depending on what the need was,” said Parker.
Dr. Gary Puckrein of the National Minority Quality Forum agreed that FFS Medicare does not incentivize coordinated care, particularly for patients with chronic conditions such as diabetes. Puckrein cited high mortality rates, hospitalization rates, emergency room visits and extended hospital as critical issues in the Medicare program.
“The problem is the Fee For Service model is fundamentally broken,” said Puckrein. “It can’t innovate in the way we need. Seventy to eighty percent of diabetic Medicare beneficiaries have hospital encounters each year. We have got to be able to lower the amount that we are spending for hospital events that are avoidable.”
Chester Speed, Vice President of Public Policy at the American Medical Group Association, said incentives within Medicare Advantage to improve care coordination particularly benefit high risk patients.
“Medicare Advantage care coordinators help high and medium risk patients navigate care and treatment,” said Speed. ‘The idea being that nurses make sure that people who are either high risk or medium risk are looked after, cared for, and help navigate a very challenging health system. In Fee For Service, there is no incentive for patient engagement activities, no incentive for reducing admissions or readmissions, or shortening a stay. Medicare Advantage is a completely different ballgame.”
As a Nurse Practitioner and President of the American Association for Nurse Practitioners, Cindy Cooke said Medicare Advantage allows for more individualized care, which is particularly key for patients who may be experiencing multiple chronic conditions.
“If you focus on the patient, the outcomes would be better,” said Cooke. “I think we all strongly believe in Medicare Advantage because it is important for us to coordinate the care of patients with chronic conditions.”
Thorpe concurred with Cooke’s remarks, stating that care should be “patient centered” and “patient focused”.
“Care teams need to be flexible because the needs of these patients are diverse,” said Thorpe. “Medicare Advantage plans are good examples of these integrated group practices by the nature of how they are developed and constructed.”
Senator Bob Casey (D-PA) concluded the event with remarks by sharing the priority Congress has given to address issues in the Medicare program, including adjusting for high risk patients.
“We have to continue to be open to new ideas and bipartisan efforts to improve Medicare itself and Medicare Advantage,” said Casey.
Casey added that Congress, the Department of Health and Human Services as well as the Centers for Medicare and Medicaid Services (CMS) are looking at how to “ensure that plans have what they need to treat some of the most complicated beneficiaries in the program.”
A working group established by the U.S. Senate Finance committee is expected to offer legislation addressing chronic disease management under Medicare by the end of the year.
• Sen. Bob Casey (D-PA), Senate Committee on Finance, Senate Committee on Health, Education, Labor and Pensions.
• Ken Thorpe, Ph.D. Emory University Chairman, Partnership to Fight Chronic Disease
• Cindy C. Cooke, DNP, FNP-C, FAANP President American Association of Nurse Practitioners
• Jim Parker President and Chief Executive Officer IU Health Plans
• Gary A. Puckrein, Ph.D. President and Chief Executive Officer National Minority Quality Forum
• Chester A. Speed, J.D., LL.M. Vice President of Public Policy American Medical Group Association