Senate Chronic Care Working Group Offers Medicare Recommendations


A Senate working group on chronic care released a first look at what chronic care legislation might look like. The 30-page document published Friday proposes several changes to Medicare to better treat patients with chronic illnesses, such as increasing telehealth opportunities and coordinating treatments for patients with multiple chronic diseases.

The working group, which lies under the Senate Finance Committee and is co-chaired by Sens. Johnny Isakson (R-Ga.) and Mark Warner (D-Va.), will start drafting legislation after Jan. 26, the deadline for suggestions from external parties. The committee says it has held 80 stakeholder meetings and received 530 comments about new policies that lawmakers could put forward.

According to staffers, this is an issue the committee is eager to tackle. Chronic care is the “biggest challenge facing Medicare,” Liz Jurinka, chief health policy adviser for Sen. Ron Wyden (D-Ore.), the ranking member on the Senate Finance Committee, said at a RealClear Health event last month.

The repeal of the Sustainable Growth Rate earlier this year freed up time for lawmakers and staffers to shift their focus to other health issues, such as chronic care.

“The whole idea here was to get away from this linear thinking of pay-fors and offsets and start thinking about bigger items like chronic care and all the other policies which we couldn’t talk about because, literally, my entire year was filled with talking about how are we going to pay for this,” Jay Khosla, chief health counsel and policy director for Finance Committee Chairman Orrin Hatch (R-Utah), said at the November event with Jurinka.

The working group suggests offering more at-home care for elderly patients with chronic illnesses by expanding Medicare’s Independence at Home project. It’s currently a demonstration project, and the working group thinks it should be made permanent nationwide. This kind of coordinated, team-based care approach can improve outcomes for beneficiaries, and the demonstration project saved more than $25 million in its first performance year.

The committee also suggests expanding Medicare Advantage to provide enrollees with hospice and other supplemental benefits. Additionally, Medicare Advantage could be made available to end-stage renal disease patients who are diagnosed before age 65.

For patients with multiple chronic illnesses, the working group recommends establishing a high-severity management code that could compensate clinicians for the extra labor of coordinating services. The working group also suggests waiving the beneficiary copayment associated with chronic care management.

The committee proposes using telehealth to identify whether someone is at risk for a stroke and changing the way some organizations are reimbursed for telehealth services. “Traditionally telehealth has been viewed as a tool to improve access to services, but interest is growing to see if telehealth has the potential to reduce health care costs,” the proposal said. “Telehealth may have the potential to replace some face-to-face office visits, reduce emergency room visits, and prevent hospitalizations. Telehealth may also keep beneficiaries in closer, more consistent contact with providers.”

Addressing chronic care is necessary as the U.S. population ages and more people are diagnosed with acute illnesses, Warner said in a statement.

“One of the next big challenges for our nation’s healthcare system is how to effectively deliver care for Medicare beneficiaries with chronic conditions,” he said. “Given the fragmentation of the Medicare program, this won’t be an easy task, and won’t happen overnight.”

Senate staffers will soon start talking to the House Ways and Means Committee to gauge its interest in the issue. Jurinka said in November that she expects the Finance Committee’s work to be well received in the House.

“The benefit of doing something that is bipartisan and hopefully does good things, is that typically that doesn’t see a lot of opposition, hopefully,” she said. “So to the extent that that can continue, I think we’re looking forward to engaging with them.”

Morning Consult