Efforts are underway throughout the Medicare program to better manage beneficiaries’ chronic conditions, with the goal of improving quality and lowering the costs of care. With an estimated 31 million Medicare beneficiaries suffering from a chronic condition such as cardiovascular disorders, diabetes and cancer, many still do not receive the coordinated services they need to manage their chronic conditions, and beneficiaries with multiple chronic conditions incur higher-than-average spending. However, traditional fee-for-service Medicare, Medicare Advantage, and newer models such as Accountable Care Organizations (ACOs) differ in the tools and methods available to manage chronic care.
This session explored questions such as: how do incentives and payment structures in traditional fee-for-service Medicare, Medicare Advantage, and newer delivery system models affect chronic care management for Medicare beneficiaries? What should people with chronic conditions consider when they decide on their Medicare coverage? Will scheduled payment reductions to Medicare Advantage jeopardize or incentivize improvements in care coordination?
A distinguished panel of experts addressed these and related questions:
If you were unable to attend the briefing, here are some key takeaways:
In opening remarks, Senator Ron Wyden noted that the focus of the Medicare program has changed from acute care to chronic care, and emphasized the importance of finding a bipartisan solution to create more coordinated mechanisms for chronic care.
Mark Miller, executive director of the Medicare Payment Advisory Commission (MedPAC), explained how the three main Medicare models: fee-for-service Medicare, accountable care organizations (ACOs), and Medicare Advantage, differ when it comes to managing chronic conditions. Issues to consider when comparing Medicare models include payment benchmarks, quality measurement, risk adjustment, and patient engagement, he noted. Miller added that MedPAC’s stated recommendation is to move towards more neutral payment methodologies between fee-for-service Medicare, ACO’s, and Medicare Advantage.
Bob Master, chief executive officer of the Commonwealth Care Alliance, emphasized the challenges and opportunities associated with improved chronic care delivery. Elements of a successful chronic care delivery system include integrated global payments to an accountable care entity, enhanced investment and redesign of primary care, and enhanced investment in community support services. The lack of access to mental and behavioral health care treatment options pose a substantial barrier to appropriate care for complex populations, he added. With continuous care improvements, Dr. Master stated, Commonwealth Care Alliance has achieved dramatic reductions in hospitalizations, nursing home placements, and associated costs.
Helen Kurre, director of medical practice integration for Providence Health Plans, explained that Providence Health Plan improves care by using data on health trends, working with individual members on care management and coordination plans, and collaborating with providers. Alignment with accountable care models at Providence, she stated, involves data collection, population management, team-based care, and alignment of incentive models.
Ed Howard of the Alliance and Kent Thiry of DaVita HealthCare Partners, co-moderated.
This event is the second in a series providing background and discussing issues associated with Medicare Advantage. Information for the first briefing can be found here.
Follow the briefing on Twitter: #MedicareAdvantage
Contact: Sarah Dash firstname.lastname@example.org (202) 789-2300
Full Transcript (Adobe Acrobat PDF)