Opinion

Policymakers Must Seize Chance to Improve Chronic Care through Coordination

Recently, both the Administration and Congress have sounded a clarion call to improve the quality and lower the cost of providing care for Medicare beneficiaries. Recently, Sen. Orrin Hatch (R- Utah.) announced the creation of a Senate Finance Committee Chronic Care Working Group to identify policy-oriented solutions to improve the quality and reduce the expense of Medicare beneficiaries’ chronic care.

It’s no wonder the Senate is tackling this particular issue – chronic care accounts for a whopping 93 percent of spending in the Medicare program.

One place to look for guidance on this issue is the stable of care coordination success stories through Medicare Advantage. Medicare Advantage, which serves more than 16 million seniors or roughly 30 percent of all Medicare enrollees, has generated evidence-based, proven strategies for reducing costs and improving outcomes for beneficiaries, particularly low-income and minority beneficiaries and those suffering from serious, complex health conditions like heart failure or end-stage renal disease. These high-risk patients benefit from the care coordination services offered by Medicare Advantage plans. Traditional Medicare plans, on the other hand, lack formalized strategies and incentives for care coordination.

As a team-based effort among physicians, advanced practice nurses, social workers, case managers, nurses and allied health professionals working together to make a difference for patients and their loved ones, care coordination is a driving force in current health care plan innovation; the strategies deployed by Medicare Advantage plans serve as a foundation for policy proposals to improve chronic care management for Medicare-eligible individuals and foster best practices for our healthcare system.

To understand what care coordination is all about and how it works on a patient level, look no further than one of the most widespread chronic conditions sweeping our nation: diabetes. According to the American Diabetes Association and the Centers for Medicare & Medicaid Services (CMS), more than 29 million Americans suffer from diabetes, including more than a quarter of all seniors and 40 percent of all African Americans and Hispanics. It is a complicated disease requiring routine and specialized care from multiple providers, detailed medication routines, and vigilant monitoring. All this care can be expensive – 10 percent of all health care dollars are spent treating diabetes and its complications.

What role does care coordination play to address costs and ensure patients get high quality care? Medicare Advantage plans offer targeted and specialized services to treat the whole patient and ensure beneficiaries are receiving the best care to treat their disease. Plans help patients and health care providers overcome language and cultural barriers to ensure treatment compliance. They focus on the special needs of this population, from foot care to obesity. They deliver personalized online health information and offer individual coaches to empower patients to manage and improve their health. They help patients become and stay active through community-based fitness programs. They provide transportation services to help patients keep their medical appointments. And they use the power of information technology to drive improvements in care. In short, they view the patient as a person and treat them as an individual, while still leveraging the benefits of scale.

This concentrated, coordinated approach is working: a study published in the January 2012 edition of Health Affairs found that beneficiaries with diabetes in a Medicare Advantage special needs plan had “seven percent more primary care physician office visits; nine percent lower hospital admission rates; 19 percent fewer hospital days; and 28 percent fewer hospital readmissions compared to patients in FFS Medicare.”

Diabetes is just one example of a chronic condition that care coordination can address. Medicare Advantage plans have created innovative special needs plans for a wide range of diseases including heart failure, dementia, chronic obstructive pulmonary disease, asthma, depression, bipolar disorder, chronic kidney disease and hypertension.

Given that nearly 70 percent of Medicare beneficiaries have two or more chronic conditions, Medicare Advantage plans have transformative potential for the system – and not just for those enrolled in Medicare Advantage. Research shows that these plan practices “spillover” to the rest of the health care system and yield more effective hospital services including lower hospitalization costs and shorter lengths of stay. A recent analysis found that a 10 percent increase in Medicare Advantage plan penetration is associated with a 2.4 percent – 4.7 percent reduction in hospital costs for other patients.

By focusing on investments in coordinated care and early-stage disease management, the Senate’s Chronic Care Working Group has a chance to recommend new policies that will help millions more Americans live healthier, happier lives through improved care. On behalf of all advocates for the advancement of care coordination, I sincerely hope they do.

Cheri Lattimer is the Executive Director of the Case Management Society of America and a member of the Medicare Advantage Care Coordination (MACC) Task Force, an initiative of AHIP’s Coalition for Medicare Choices (CMC) which includes leading senior, patient, provider, caregiver, insurer, and minority health organizations and that is dedicated to promoting coordination and patient-centered care delivery in Medicare.

Correction: this article was updated to show that Sen. Orrin Hatch is from Utah.