January 15, 2014

Bipartisan, Bicameral Medicare Reforms Seek to Improve Care and Lower Costs

Wyden-Isakson-Paulsen-Welch Push for Focus on Chronic Illnesses

WASHINGTON – U.S. Senators Ron Wyden, D-Ore., and Johnny Isakson, R-Ga., and U.S. Representatives Erik Paulsen, R-Minn., and Peter Welch, D-Vt., today introduced bipartisan, bicameral legislation aimed at providing better care at lower cost for the millions of Medicare beneficiaries with multiple chronic conditions.

The Better Care, Lower Cost Act seeks to improve care coordination for beneficiaries with multiple chronic conditions, the most-expensive and fastest-growing portion of the Medicare population. The legislation would expand the use of multidisciplinary health teams to keep patients as healthy as possible in their homes and communities.

According to Centers for Medicare and Medicaid Services, 68 percent of Medicare enrollees have multiple chronic conditions, and account for 93 percent of Medicare spending. Additionally, 98 percent of costly hospital readmissions involved beneficiaries with multiple chronic conditions.

“Medicare is now dominated by cancer, diabetes, heart disease and other chronic conditions,” Wyden said. “Medicare reform must be built around offering better quality, more affordable care for these seniors.  Fortunately, there are pioneering practices and plans that are paving the way. The point of our bipartisan legislation is to break government’s shackles on innovation so that these providers are the norm rather than the exception.”

“I believe that the best and most innovative solutions come from the private sector and people on the ground, and my hope is that the Better Care, Lower Cost Act will unleash the creativity of the medical community to develop ways to provide better care at a lower cost,” said Isakson. “I’m proud to join Sen. Wyden in introducing this legislation, which addresses our health care system’s challenge of managing chronic medical conditions by allowing patients to voluntarily enroll in a program that incentivizes health care providers to invest in prevention and keeping patients healthy. I encourage my Senate colleagues to support this legislation because it is critical to the future of Medicare and our health care system.”

“We need to modernize Medicare to drive quality and lower costs,” Paulsen said. “Focusing reform on chronic care management will not only improve the overall health of our seniors, it will decrease costs and help to ensure long-term solvency of the Medicare program. By taking advantage of technology, such as telehealth, to break down geographic barriers that currently plague the system, we can bring the chronic care management skills and experience of providers like Minnesota’s Mayo Clinic to the most rural parts of the country.”

“It is essential that we do a better job coordinating health care services for seniors suffering from chronic diseases,” Welch said. “Every day, these seniors struggle to navigate a maze of health care providers, too often on their own. This bill, built on Vermont’s successful Blueprint for Health, will encourage providers to coordinate care and reward them for achieving healthy outcomes rather than for the number of services they provide. It’s a common sense solution that is long overdue.”

The legislation creates the “Better Care Program,” allowing health plans and groups of providers to form “Better Care Plans” or “Better Care Practices,” (BCPs) respectively. This program would be voluntary and open to Medicare enrollees suffering with chronic illnesses. Participating plans and practices would receive newly calculated risk-adjusted, capitated payments rewarding better health outcomes for enrolled beneficiaries.  

BCPs would be allowed to focus and specialize in chronic care delivery and management. Under current law, the so-called “attribution rule” strictly limits the ability of provider-led organizations to reach out to sicker patients and provide them with the highest-quality, integrated chronic care services.

Existing integrated care delivery models are largely limited to the Pacific Northwest, Midwest and Northeast, leaving millions of Medicare enrollees without access to this more-effective and cost-efficient model of care. In these areas, the legislation provides opportunities to go further.

In rural or underserved areas where integrated delivery models may not be as prevalent, the legislation provides a direct focus to so-called ‘hot spots’ where there is a high prevalence of chronic disease. Further, the bill would encourage the expansion of telemedicine health IT, and ensure that health providers in underserved areas could practice at the top of their licenses.

Additionally, the bill would encourage medical schools to focus on team-based care as well as geriatrics and chronic disease management.

The legislation has already attracted a wide range of interest and support:

"This bipartisan legislation offers a solution that the millions of seniors and disabled Americans with chronic conditions badly need- personalized care tailored to their needs and preferences delivered by collaborative teams of health care professionals. As established by this legislation, the Medicare Better Care Program is a serious solution, commensurate with the challenge chronic disease poses to the Medicare's future. And to its authors' credit, the bill reflects a growing consensus among providers and health care experts on the need to more effectively align incentives with higher-value and focus on high-cost, high need. Whatever other divisions plague Congress, this is one solution that all Senators and Representatives should be able to support." - John Rother, President and CEO, National Coalition on Health Care

“As a country, we must tackle the most challenging aspects of the health care system to reduce patient suffering, improve clinical outcomes and achieve greater efficiency. This proposal catapults U.S. health policy into the realm of care delivery and seeks to remove barriers to better care coordination. By organizing clinicians around the needs of Americans with chronic diseases, we have the potential to deliver a better patient experience and outcomes, while reducing costs.” - Thomas Lee, Chief Medical Officer, Press Ganey

“Senator Wyden has crafted a model that puts patients first. As an academic health system committed to new models of care, we support direct payment to cover the full scope of wraparound care that patients with chronic disease need. The burden of chronic disease is enormous - for individuals and the nation. We can best relieve the burden with doctors and professionals at all levels working with patients to maintain their health." – Dr. Steven M. Safyer, President and CEO, Montefiore Health System

“Providence applauds Sen. Wyden's leadership in developing a new care model for chronically ill seniors. This bill will not only advance the sustainability of the Medicare program, it will also allow health systems, such as Providence, to create individualized care for seniors that effectively utilizes the entire care continuum.” - Dr. Rod Hochman, CEO, Providence Health and Services

"Emphasizing care integration and providing quality-driven incentives to both patients and providers, the "Better Care Program" will improve the health of most vulnerable Medicare beneficiaries and bend the health cost curve.” - Dr. A. Mark Fendrick, Director, University of Michigan Center for Value-Based Insurance Design

“We applaud Sens. Wyden and Isakson and Reps. Paulsen and Welch for their hard work toward improving care for our chronically ill population. Their approach to gain insights from across healthcare disciplines is a positive step toward more patient-centered care. Amedisys looks forward to continuing this dialogue on behalf of our patients, their families and the evolution of the Medicare program.” - Dr. Michael O. Fleming, Chief Medical Officer, Amedisys

“We will never make Medicare more affordable for seniors, the disabled and taxpayers until we tackle the costs of chronic illnesses. Medicare is one of the last federal programs to benefit from modern health management tools and program-wide care coordination. The bill changes that by transforming Medicare from an indifferent, uncoordinated payer of discrete services, to one that aligns incentives to produce better outcomes at lower costs. We are particularly excited that the bill may create new incentives to address poor medication adherence, a problem that impacts millions of Americans through chronic disease progression at a cost of almost $300 billion annually. The Better Care, Lower Cost Act is appropriately named.” - Joel White, President, Council for Affordable Health Coverage

“AARP appreciates the bipartisan efforts of Senators Ron Wyden and Johnny Isakson and Representatives Erik Paulsen and Peter Welch to improve the health and care of Medicare beneficiaries with multiple chronic conditions. Approximately one in four Americans has multiple chronic conditions and approximately two out of three Medicare beneficiaries have multiple chronic conditions. Seventy five percent of our health care dollars goes to the treatment of chronic diseases. It is important to better coordinate and improve the quality of care for these individuals, with the opportunity to better control or reduce costs in the process, rather than to just ask individuals to continue to pay more for their health care. We appreciate these bipartisan efforts to address chronic care and look forward to seeing the details of the legislation. We will continue working with the bill’s sponsors and others on both sides of the aisle to address this important issue.” - David Certner, AARP’s Legislative Counsel and Legislative Policy Director

The press conference announcing the bill can be found at http://www.youtube.com/watch?v=xmjJpSrOKlQ. For more information, go to www.wyden.senate.gov/chroniccare