Medicare Reforms that will Improve Care Coordination for Chronically Ill Patients

In Medicare today, health care for individuals with chronic conditions accounts for a staggering share of overall Medicare spending—a significant change from 1965 when Medicare started. In 2012, the Centers for Medicare and Medicaid Services (CMS) published a report detailing the prevalence and impact of chronic conditions. Beneficiaries with six or more chronic conditions represent only 14% of the Medicare Fee for Service beneficiary population but tally 46% of total Medicare spending. 

In fact, the expense of a few combinations of chronic diseases drives Medicare spending to an astonishing degree. The four costliest three-disease combinations include beneficiaries with stroke, chronic kidney disease, and either asthma, chronic obstructive pulmonary disease, depression, or heart failure.

Total per capita costs for beneficiaries with these combinations of disease exceed $60,000—seven times that of the average Medicare beneficiary.

Background on Legislation

Senator Wyden proposed legislation in 2014 that would have established Better Care Plans (BPCs), a variation on Accountable Care Organizations, aimed at improving coordination of high cost, chronically ill Medicare beneficiaries. By requiring beneficiaries to actively enroll in such plans, they offered the potential to better engage patients, as multiple panelists at the event recommended.

Subsequently, in July 2014, the Senate Finance Committee held a hearing on how to address the unmet needs of patients with chronic illness, focusing on experiences of patients, caregivers, payers and health systems that have been involved in care for individuals with chronic disease. The following Finance Committee hearing on chronic care, in May 2015, focused on how to mobilize a plan, with prominent policy administrators and experts Patrick Conway and Mark Miller as witnesses.

Building on this, Senators Wyden and Hatch announced the launch of an on-going, bipartisan working group on improving chronic care for Medicare beneficiaries that released a policy options paper in December 2015 that outlined six key areas of reform. 


Executive Editor

Ms Anna Sullivan

Ms Anna Sullivan