Rx: More Reasoned, Practical Thinking

Terry H. Schwadron

July 1, 2018

Several weeks ago, as part of the budget legislation that worked through Congress and gained President Trump’s signature, there was good news for senior facing multiple chronic illnesses as well as social problems, like getting to a doctor or installing safety bars in bathrooms.

That most rare of circumstances — a bipartisan agreement — pushed through the Chronic Care Act — and once the budget passed, Medicare officials could move ahead to integrate it with private insurance carriers. As such, it was a bipartisan move to improve selected and targeted health care for seniors by including the cost in private supplemental insurance rather than federal spending — a new model.

And no one was targeted by destructive tweets along the way. It’s enough to restore a bit of hope that reasonable minds agreeing on an actual problem might come up with actual solutions.

These particular improvements are getting less attention than, say, the continuing effort by Republicans in Congress to cut overall Medicare benefits or to seek overall entitlement program reductions. But a recent article by Robert Pear, a health care reporter for The New York Times, describes the changes as something that seems almost daring for tackling a complex problem with intelligence, research, results-oriented thinking that drew consistent support from Democrats and Republicans alike. Amazing.

In one effort, these changes approach dealing how long-term illnesses can build on one another and the social factors outside traditional medicine like nutrition, transportation and housing, that can contribute. And the approach promises to save Medicare money, say Medicare officials, even if you and I pay for it through insurance.

The bill is “revenue neutral” because it encourages insurers providing supplemental Medicare coverage to include these approaches, which include such common-sense services as hot meal delivery, installation of grab bars in bathrooms, and transportation to doctors, as covered services.

It makes you wonder why other social problems are shunted off to the realm of sloganeering rather than resolved. Indeed, the entire anti-Obamacare attitude in Congress is a call to avoid such preventive care to reduce the cost of insurance premiums.

The numbers: More than 60 percent of Medicare recipients are covered by such insurance policies. More than half of Medicare recipients are treated for five or more chronic illnesses, and they account for about 75% of Medicare spending. So, reducing the cost of services to these patients through more preventive means obviously will reduce more expensive hospital-based services. Preventing one fall, for example, reduces the chances of addressing a broken hip or pelvis.

Congress allowed Medicare plans to offer a wider array of supplemental benefits to the chronically ill, eliminating the current requirement that the extra benefits must be “primarily health-related.”

As Pear describes, Medicare officials have been working with insurers to assure that

Medicare Advantage plans must cover all the services. Until now, the government has generally required each Medicare plan to offer the same benefits with the same cost-sharing to all beneficiaries. The Trump administration has reinterpreted the “uniformity requirement” to allow different supplemental benefits for people with different medical needs. Congress went further and allowed Medicare officials to waive those requirements for patients with chronic illnesses.

Although Medicare Advantage plans will provide most of the services, their experience will be useful to those who want to extend similar benefits to people in the rest of Medicare.

According to a summary of the Chronic Care Actlanguage, the approach wouldwould drastically reduce the costs and frequency of hospital visits, freeing up hospital staff to deal more effectively with non-chronic patients and allow chronically-affected beneficiaries to pursue care options that are less disruptive and more tailored to their conditions and lives.Basically, it tilts towards having more home-based services.

Medicare plans could also reduce co-payments and deductibles for people who receive treatment for a particular medical condition from certain recommended doctors, hospitals or other health care providers, Pear explained.

The article quoted insurers as saying the extra benefits could include visits by a personal assistant to help with bathing and dressing; visits by a nurse or a pharmacist to make sure a Medicare beneficiary with a dozen prescriptions is taking the right medicines; and special supervised housing for a person with dementia who cannot be left alone. One predicted rapid growth in the use of high-tech pill dispensing machines, remote monitoring of homebound people and telehealth services to connect patients with doctors far away.

The Chronic Care Act provides new incentives for the use of telehealth services, including coverage for stroke patients.

Companies like Lyft have expressed interest in providing more reliable health-appointment transportation for those who do nor have it. Meals on Wheels are prepared to add services for checking on health and safety as well as providing meals.

The bill was jointly sponsored by Senators Ron Wyden (D-OR), Orrin Hatch (R-UT), Mark Warner (D-VA) and Johnny Isaakson (R-GA), and a rare successful bipartisan cooperation.

The only question is why not more of this?



Journalist, musician, community volunteer