An aging population with multiple chronic conditions will require Medicare to take a more coordinated approach to patient care, according to a panel of health policymakers.
Sen. Ron Wyden, D-Ore., explains the importance of moving to a single payment for chronic care management during a recent panel discussion.
The panel, made up of federal officials and insurance representatives, discussed the most effective ways to provide and pay for chronic care management during a recent Alliance for Health Reform event here.
Two-thirds of Medicare recipients in fee-for-service programs have two or more chronic conditions, and they constitute 90 percent of Medicare spending. This year, CMS began paying physicians for a chronic care management code that recognizes those patients.
During the event, Sen. Ron Wyden, D-Ore., noted that Medicare Advantage, which now covers an estimated 15 million people, offers a blueprint for designing chronic care treatment.
"Today, Medicare is about chronic disease," Wyden said. "It's about cancer, diabetes, heart disease and strokes. If you put Alzheimer's on top of that, that's the whole ballgame. Medicare has become the country's premier chronic care program. This is going to be the challenge of our time."
- An increase in the number of chronic care patients is leading to a change in how Medicare is delivered.
- A panel of health policymakers called Medicare Advantage a successful model for chronic care management.
- For chronic care delivery to improve, insurers need to make single payments, the panel said.
Despite the best attempts of public and private insurers to develop alternative payment models, a high percentage of payments are still fee-for-service.
Oregon is second only to Minnesota in the percentage of individuals in Medicare Advantage, said Wyden, yet more than half of its seniors are in fee-for-service programs. The state has 19 different Medicare Advantage plans, which are approved by Medicare but operated by private insurers.
"I think it's time to take fee-for-service out back and give it a dignified burial," Wyden said. "Nobody would go to a store looking to buy one piece at a time."
He said the best way to encourage coordinated care among physicians, pharmacists and other health professionals is to move to a single insurer payment for both public and private plans.
Wyden is co-sponsoring a bill that would offer greater incentives for coordination of care.
"You can't get providers to make the investment in coordinated care unless they know the return is going to be consistent," he said.
Even under a single-payment system, the type of care offered to patients, especially the elderly, will have to change to increase patient engagement, Wyden said. Medicare provides recipients with a free physical, but most patients still simply walk out of the doctor's office after the exam without engaging in a discussion about wellness efforts, he noted.
Eliminating fee-for-service is the stated goal of many physicians and policymakers, but alternative payment models are not always the least expensive option. Mark Miller, Ph.D., executive director of the Medicare Payment Advisory Commission, said the commission's reports indicate that in select markets, fee-for-service sometimes costs less than accountable care organizations and Medicare Advantage.
Despite those findings, the need to increase payments for chronic care is apparent, said panel members.
"We've been underpaying plans for chronic care and overpaying for healthy patients," Miller said.