Expand Care Coordination and Services for High-Cost, High Need Beneficiaries

In both public programs and the private sector, 5% of patients account for 50% of health care costs. These patients typically face multiple chronic conditions and functional limitations that together lead to enormous health care costs, disability and premature mortality. Better care and services for these often-vulnerable individuals is both a fundamental moral responsibility and an indispensable element of any serious effort to curb overall health care spending.

Improve Chronic Care in Medicare Advantage and Medicare Accountable Care Organizations (ACOs)
In Medicare, meeting that responsibility means doing more to help MA plans and ACOs to improve care and lower costs – particularly for the most vulnerable patients.

  • Risk adjustment must fully account for the additional cost of caring for dually eligible, frail or disabled beneficiaries.
  • Medicare’s STARS quality bonus payments should recognize and reward—not punish—plans that take on the challenge of managing sicker, lower-income and frailer patient populations.
  • To encourage a more robust response to the social determinants of health, Congress should remove regulatory barriers that prevent accountable entities (health plans or ACOs) from investing program dollars on behavioral health, housing and social and long-term services and supports.

Patient-Centered Care Planning
Any patient’s or consumer’s priorities should drive the care and services they receive. But when chronic disease evolves into serious or advanced illness, it is particularly critical that a patient’s own preferences and choices guide the course of treatment. NCHC supports the following improvements to the current benefits in Medicare and across our health care system:

  • Ensure that palliative care options are available and made known to patients throughout the course of illness
  • Improve care for patients with advanced illness by reimbursing for end-of-life planning
  • Reimburse for care planning offered to patients upon diagnosis of Alzheimer’s Disease

Resources
Joint Letter of Support for the Community Based Independence for Seniors Act (HR 4212) (June 2016)
NCHC Letter on Substance Abuse Records Disclosure (April 2016)
NCHC Letter of Support: CONNECT for Health Act (March 2016)
NCHC Fact Sheet: Care Coordination for High-Cost, High-Need Beneficiaries
NCHC Response to Chronic Care Working Group’s Policy Options Document (January 2016)
NCHC Letter to the Senate Finance Committee Chronic Care Working Group (June 2015)
NCHC Letter of Support for the Medicare Independence at Home Practice Demonstration Expansion Act of 2015 (June 2015)
NCHC Letter of Support for the Senior’s Health Care Protection Act (June 2015)
Joint Letter on Protecting and Strengthening Medicare Advantage (February 2015)
Op-ed – Medicare Cuts Put Coordinated Care at Risk (March 2014)
NCHC Forum –  A Prescription for Savings: Medication Management and Improved Adherence (March 2014)
NCHC Forum – Roundtable on Chronic Care with Senator Johnny Isakson (R-GA) and Senator Ron Wyden (D-OR) (November 2013)