Se­nate eyes changes to Medi­care Ad­van­tage, ex­pand­ing telemedicine

Modern Healthcare - - NEWS - By Mara Lee

For stroke pa­tients, re­ceiv­ing a crit­i­cal clot-bust­ing drug within 90 min­utes of symp­toms on­set can make all the dif­fer­ence. Those who get the drug within that time frame are three times more likely than other stroke pa­tients to re­cover with no dis­abil­ity, ac­cord­ing to Dr. Lee Sch­wamm, di­rec­tor of the Part­ners Tele­stroke Net­work at Mas­sachusetts Gen­eral Hos­pi­tal in Bos­ton.

A key prob­lem is mak­ing sure a neu­rol­o­gist is on duty. It’s a dilemma for ur­ban and ru­ral hos­pi­tals. Just 2.4% of Medi­care pa­tients who had is­chemic strokes re­ceived the drug in time, Sch­wamm told a Se­nate panel last week. Tech­nol­ogy, though, can greatly bol­ster those num­bers. Af­ter im­ple­ment­ing tele­stroke net­works, hos­pi­tals at least dou­bled the num­ber of pa­tients get­ting the drug in the crit­i­cal pe­riod.

“Tele­stroke is sup­ported by a wealth of ev­i­dence and is a com­mon-sense, cost-ef­fec­tive step that the com­mit­tee can take to re­duce the bur­den of stroke as a chronic dis­ease,” Sch­wamm said.

Medi­care now re­im­burses telemedicine only in ru­ral ar­eas. Ex­pand­ing its us­age was just one of the top­ics the Se­nate Fi­nance Com­mit­tee ex­plored at the hear­ing. The com­mit­tee also heard tes­ti­mony on how chang­ing rules that gov­ern Medi­care Ad­van­tage, ac­count­able care or­ga­ni­za­tions and value-based in­sur­ance de­signs could im­prove health and re­duce spend­ing on Medi­care pa­tients with mul­ti­ple chronic con­di­tions.

A bi­par­ti­san group of se­na­tors, known as the chronic care work­ing group, has al­ready seen six of its pol­icy pro­pos­als re­al­ized through CMS rule­mak­ing and the 21st Cen­tury Cures Act. The Se­nate Fi­nance Com­mit­tee last week ap­proved the CHRONIC Care Act, which in­cludes a num­ber of the work­ing group’s re­main­ing pri­or­i­ties.

The bill would al­low Medi­care Ad­van­tage plans to use tax­payer money for so­cial sup­ports, such as de­liv­er­ing meals tai­lored to pa­tients with di­a­betes or con­ges­tive heart fail­ure; rides to doc­tors’ ap­point­ments; and home mod­i­fi­ca­tions. Un­der cur­rent law, any add-ons in Medi­care Ad­van­tage have to be avail­able to all plan mem­bers.

Kather­ine Hayes, di­rec­tor of health pol­icy at the Bi­par­ti­san Pol­icy Cen­ter, said a pi­lot study found that bring­ing such sup­ports to peo­ple with mul­ti­ple chronic con­di­tions re­duced med­i­cal costs by up to 27%.

Medi­care Ad­van­tage al­ready has the author­ity to de­sign plans for com­plex pa­tients like these who also qual­ify for Med­i­caid fund­ing un­der spe­cial needs plans, but the bill would make spe­cial needs plans a per­ma­nent part of the Ad­van­tage pro­gram.

John Lovelace, pres­i­dent of the UPMC sys­tem’s Medi­care Ad­van­tage, CHIP and Med­i­caid plans, said the Pitts­burgh-based sys­tem has been of­fer­ing spe­cial in­cen­tives for peo­ple with di­a­betes, con­ges­tive heart fail­ure and de­pres­sion to en­cour­age them to talk to health coaches and set goals to im­prove their health. This sort of ap­proach should be avail­able more widely, he said, not just in the seven states ex­per­i­ment­ing with value-based in­sur­ance de­sign in Medi­care Ad­van­tage.

The CHRONIC Care Act would ex­pand value-based in­sur­ance de­sign and also al­low ACOs to pay up to $20 per qual­i­fy­ing ser­vice, di­rectly to the ben­e­fi­ciary, to en­cour­age them to stay en­gaged in treat­ment.

Lovelace ac­knowl­edged that the sys­tem doesn’t know yet whether its four­phase $100 in­cen­tives are work­ing, but he said UPMC com­mer­cial pro­grams use in­cen­tives that have shown re­sults.

Among 65,000 UPMC em­ploy­ees, 85% have agreed to well­ness and health coach­ing to lower their in­sur­ance de­ductible by $1,000.

Sen. Tom Carper (D-Del.) asked Mon­te­fiore Health Sys­tem’s Stephen Rosen­thal what one piece of ad­vice he would give the Se­nate to re­verse the obe­sity epi­demic .

“It be­gins in the schools,” said Rosen­thal, se­nior vice pres­i­dent for pop­u­la­tion health man­age­ment. He said by ado­les­cence, many kids are al­ready obese and it’s much harder to lose weight once you’ve gained it.

The CHRONIC Care bill does not ad­dress that kind of preven­tion, but this month, the U.S. Depart­ment of Agri­cul­ture rolled back whole grain and milk rules that were part of nu­tri­tion im­prove­ments to school lunches cham­pi­oned by former first lady Michelle Obama.

Af­ter im­ple­ment­ing tele­stroke net­works, hos­pi­tals at least dou­bled the num­ber of pa­tients get­ting the drug in the crit­i­cal time win­dow.

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