Insights

Medicare sees more care coordination in its future

By: 
Ken Thorpe, PhD

Roll Call and Collaborative Health Systems recently hosted a joint briefing, “ACOs: The Future of Coordinated Care,” to discuss the role of coordinated care in the U.S. health care system. Through coordinated care, teams of physicians and care coordinators help patients smoothly transition from one medical setting to the next. Patients with chronic conditions often see multiple specialists, so care coordination is a valuable part of their health care experience. In fact, efforts to better coordinate care within the Medicare program are a driving force in the “value-based care” movement, which aims to improve health outcomes and care quality while reducing costs.
 
At the briefing, Meena Seshamani, MD, Director of the Office of Health Reform at the Department of Health and Human Services (HHS), and Karen Fisher, Senior Health Counsel for the Senate Finance Committee – both physicians – discussed their experiences working at the center of this movement. First, Dr. Seshamani discussed HHS’ goal of transitioning over 50 percent of Medicare payments to value by 2018[i] to emphasize the agency’s leadership in incentivizing more care coordination. She also touted two HHS pilot programs, The Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model[ii] and the Oncology Care Model[iii], as new milestones in the agency’s effort to provide higher quality care for Medicare beneficiaries.
 
Her praise was justified the next day when HHS announced the “Comprehensive Care Joint Replacement” (CCJR) model, the most expansive effort yet to shift Medicare to value-based care. The new rule bundles hip and knee replacement payments in 75 metropolitan areas in a flat payment and penalizes physicians who underperform in these routine surgeries.[iv]
 
Following Dr. Seshamani, Karen Fisher praised the Senate Finance Committee’s new Chronic Care Working Group, which aims to address gaps in chronic care to improve care coordination for the chronically ill. Over 50 percent of Medicare beneficiaries have five or more chronic diseases[v], which accounts for 80 percent of Medicare spending.[vi] Fisher noted that the inefficient, FFS payment system has only increased spending on the chronically ill and fails to incentivize effective chronic care for millions of seniors, resulting in more hospital admissions and higher utilization of health care services.
 
Fortunately, Medicare Advantage (MA) successfully delivers high-quality, coordinated care for beneficiaries, particularly the chronically ill. In 2003, MA developed Chronic Conditions Special Needs Plans (C-SNPs), specifically to help coordinate care and treatment for chronically ill beneficiaries. A study published in Health Affairs found that beneficiaries with diabetes in C-SNPs that coordinate care had significantly lower rates of utilization and hospital readmissions compared to those in FFS Medicare.[vii] The impressive care quality and cost savings that C-SNPs provide offer important lessons for traditional Medicare as it transitions to value-based care.
 
Care coordination is key to Medicare’s sustainable future. This year Medicare has seen dynamic changes, and as the program evolves, coordinated care will only continue to improve the health of beneficiaries and the program as a whole.


[i] http://www.hhs.gov/news/press/2015pres/01/20150126a.html

[ii] http://innovation.cms.gov/initiatives/Million-Hearts-CVDRRM/

[iii] http://innovation.cms.gov/initiatives/Oncology-Care/

[iv] https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-1719...

[v] http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trend...

[vi] http://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medic...

[vii] http://content.healthaffairs.org/content/31/1/110.full?sid=4d823c73-80f2...

 

Date: 
Wednesday, August 5, 2015