By Emily Ethridge, CQ Roll Call
January 15, 2014 -- A bipartisan, bicameral group of lawmakers will soon announce the introduction of a bill to create Medicare plans to treat patients with chronic diseases, one of the program's biggest cost drivers.
Sen. Ron Wyden, D-Ore., a sponsor and the possible incoming chairman of the Finance Committee, said the measure would focus on providing better care and lowering costs, rather than cutting benefits or keeping Medicare as it is. Democratic Rep. Peter Welch of Vermont and Republicans Sen. Johnny Isakson of Georgia and Rep. Erik Paulsen of Minnesota also are sponsors of the measure.
The measure would create a new designation of a "Better Care Plan" (BCP) for providers to create coordinated care teams for Medicare beneficiaries with chronic conditions, according to a summary. Participating providers and plans would receive a risk-adjusted, capitated payment per enrollee. The Centers for Medicare and Medicaid Services (CMS) would determine that payment based on the cost of providing care for similar beneficiaries not enrolled in a BCP program.
The lawmakers said the BCP program would be superior to accountable care organizations, which also focus on coordinated care, for several reasons. For one, accountable care organizations (ACOs) are required to serve all beneficiaries seeking care, while providers in the BCP can target and enroll specific patients with chronic needs, and give them care before they become acutely sick.
In addition, ACOs participating in Medicare's typical fee-for-service system do not get more payments for coordinating care, and are eligible for shared savings only after a three-year period. The BCP program would give providers a set capitated payment per beneficiary.
CMS found that in 2010, 68 percent of Medicare beneficiaries had two or more chronic conditions and accounted for 93 percent of Medicare spending, or roughly $487 billion per year, the lawmakers noted in a release about the measure. The lawmakers said those beneficiaries also account for 98 percent of hospital readmissions.
The lawmakers may look to add the measure to "doc fix" legislation (S 1871, HR 2810) that would replace Medicare's sustainable growth rate physician payment system. Wyden and Isakson offered several elements of the bill as amendments to the legislation during a Finance Committee markup, but ended up withdrawing them.
Under the measure, the BCPs could lower a beneficiary's cost sharing for services that provide the best value for the patient's condition. In addition, each beneficiary in a BCP would receive an individual care plan.
The lawmakers said the bill would allow nurses and physicians to lead care teams, and use telemedicine and knowledge networks to provide better access to care in rural areas. It also would provide for changes in medical school curricula to prepare providers to respond to the needs of chronically ill patients.