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Medicare Advantage Is Addressing Health care’s Chronic Disease Challenge

Mary R. Grealy, President, Healthcare Leadership Council
Tuesday, January 19, 2016

One of the most important, and least visible, stories in health care today concerns the impact that chronic illnesses like diabetes, heart disease and cancer are having on the Medicare program.  Federal data shows that two of every three Medicare beneficiaries have multiple chronic conditions and this drives increasing spending in a program that will reach financial insolvency in the next 15 years, according to the most recent Medicare Trustees report.

To address this issue, it is essential to find ways to provide care that enables cost containment while achieving optimal health outcomes.  Fortunately, Medicare Advantage is illuminating that pathway to high-quality, cost-effective care that our nation, and the Medicare program specifically, needs today and for a future that will see a rapidly growing senior population.

In 2015, the Healthcare Leadership Council, a coalition of chief executives from companies representing all health sectors, hosted a Capitol Hill briefing for congressional staff members on the Medicare Advantage program.  The information presented at this event was enlightening and, in fact, showed through specific examples that Medicare Advantage is successfully addressing healthcare’s chronic disease challenge.

MemorialCare Health System, a multi-hospital system based in southern California, discussed the care it is able to provide for the 28,000 Medicare Advantage plan members it serves.  MemorialCare leaders emphasized that Medicare Advantage funds and emphasizes a coordinated care approach.  At their hospital system, this means services such as health coaching, preventive screenings, a nurse hotline available 24 hours a day, primary care case management and disease management programs for a host of conditions from diabetes to COPD.

The results have been striking.  For diabetes patients alone, MemorialCare reported, as a result of its coordinated care programs, a 50 percent reduction in 30-day readmission rates, a 41 percent decrease in emergency room admissions and a 53 percent decrease in hospital admissions.

Mirroring these statistics was a presentation by SCAN Health Plan, which provides Medicare Advantage services to seniors in California and Arizona.  SCAN’s approach, involving care navigation services, post-hospitalization health coaching, disease management and interdisciplinary case management, had achieved a hospitalization rate 14 percent lower than that for the California fee-for-service system for patients dually eligible for Medicare and Medicaid.

This evidence tells us that answers exist for the most daunting challenges facing our healthcare system.  To address the threats to our society and our healthcare system posed by escalating chronic disease incidence rates, we need to take a closer look at the lessons being provided by Medicare Advantage plans and providers.