Just in time for the holidays, evidence that our embattled political parties are capable of working together for the greater good of the citizens. No, I am not referring to the most recent bastardized budget bill, which only hoses the average person once again, I am talking about the “Bipartisan Chronic Care Working Group Policy Options Document.” The treatment of people with multiple chronic illnesses is the focus of this august body and the paper outlines some ideas they are considering. (Policy Paper) It is worth paying a little attention to these kinds of releases, because they often become the source of future legislation, although usually perverted by lobbying from various corporate and other interests for specific goodies to benefit them. According to this paper, there are three main “bipartisan” goals that chronic care policy should meet–increase of care coordination across care settings and providers; changing Medicare reimbursement to incent the proper level of care for chronic disease beneficiaries; and facilitating delivery of high quality care with better patient outcomes while reducing spending growth. These objectives are apparently in opposition to partisan ones that would encourage worse care, raise spending and lessen care coordination. The group says there are no easy answers; let me translate, this means it will be difficult for the Senators to choose from all the agendas put forth by lobbyists who give us lots of money. The big question for the politicians–is there a way that we can keep everyone happy enough that they all give us large contributions?
Some specific ideas include expanding the “Independence at Home” demonstration, increasing use of home dialysis treatment, including hospice care under Medicare Advantage plans, allowing ESRD beneficiaries to enroll in MA plans, making the Special Needs Plans permanent, allowing physicians to be further reimbursed for providing care to complex beneficiaries with multiple chronic diseases, improving integration of behavioral health and medical care, allowing MA plans greater flexibility in structuring benefits to meet the needs of chronic illness patients, encouraging greater use of telehealth by MA plans and ACOs, making changes to the risk-scoring model to ensure that the full cost of caring for these beneficiaries is calculated, changing how beneficiaries are assigned to an ACO, developing new quality measures for chronic condition care, waiving beneficiary copays to encourage use of care management services, improving ACO ability to coordinate care, expanding access to digital coaching and a few other items. Quite a list, and we should expect to see at least some enacted into law in coming years.