Senate eyes changes to Medicare Advantage, expanding telemedicine

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.