I’m sure it wouldn’t be a best seller, but it’s almost as if we need a mobile-phone app to keep up with the new Medicare care coordination programs from the federal government.
One day it’s the Pioneer ACO program, the next it’s the Independence at Home Demonstration. The Centers for Medicare & Medicaid Services is concentrating on unnecessary hospital readmissions, the cost of care for dual eligibles and new payment models for physicians. Many of the efforts make sense, but they all beg the question: why didn’t all of this start earlier? Didn’t policymakers know that the baby boomers were hitting Medicare-eligible age starting in 2009-2010? Weren’t most of us aware that the fee-for-service system for Medicare would eventually snap?
Clearly, the Affordable Care Act is accelerating reform of Medicare, but the other big issue is the worsening financial trouble of the federal government, which will force difficult budget choices. ACOs, dual-eligible coordination and other initiatives all show promise, but the payoff will be years ahead of us. One has to wonder how patient Congress will be.
Among the programs under way, two show promise, although in different degrees. CMS is ready to pour money into better coordinating care for dual eligibles, those who are eligible for both Medicare and Medicaid benefits. Duals are among the sickest and poorest individuals covered by these programs. They comprise only 15 percent of Medicaid enrollment, yet represent 39 percent of annual expenditures; for Medicare, duals represent 21 percent of enrollment and 36 percent of spending.
CMS is asking states to submit proposals on how to better care for this population and most people believe the efforts will lead to more health plan enrollment of duals—currently they enroll only 5 percent of this population.
The second promising program is the Independence at Home Demo, which will target seniors who have multiple chronic diseases. CMS will pay care coordination fees to nurse practitioners and physicians who deliver care in homes for at least 200 seniors per practice. Up to 50 practices throughout the country will be chosen.
The dual-eligibles programs could impact millions of chronically ill patients, while the Home Demo will touch just 10,000. But both will have caregivers helping people too sick to get to the doctor, pick up their prescription or too mentally impaired to understand the ins and outs of their treatment. All of this is common sense. Now that these programs are finally under way, let’s hope that they’ll keep the funding flowing.