Paying for LTSS via Medicare would improve outcomes, lower costs: report

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Bill Hoagland, a senior vice president at Bipartisan Policy Center, discusses a report released Tuesday.
Bill Hoagland, a senior vice president at Bipartisan Policy Center, discusses a report released Tuesday.

Finding a way for to pay for long-term services and supports through Medicare for some residents of independent and assisted living communities and seniors living at home “would not only improve care but also lower the beneficiaries' medical costs while also slowing expenditures from the public purse,” said Bill Hoagland, a senior vice president at Bipartisan Policy Center, at the Tuesday release of a new report from the center.

“The focus of our report we're releasing today is a set of recommendations that would allow health plans and providers to give low-tech, high-touch types of services to an estimated 3.7 million Medicare beneficiaries who have three or more chronic conditions and functional or cognitive impairments,” he said.

Annually, according to the BPC, each of these older adults incurs approximately $30,000 in Medicare expenses, more than double the average Medicare beneficiary. Services such as targeted care management, non-emergency transportation to medical appointments, home modifications and in-home meal delivery could “reduce emergency visits, lower hospital readmissions and help improve the overall health of these chronically ill individuals,” Katherine Hayes, BPC health policy director, said in a statement.

“The idea here is quite simple in a way,” Melinda Abrams, vice president of delivery system reform of the Commonwealth Fund, one of the two funders of the report, said at the document's unveiling. “If we can improve the financing for home- and community-based care, not only will it help the beneficiaries with multiple chronic conditions and functional limitations but [it will] also help their families. It's person-centered, and it's cost-effective.”

Bruce Chernof, M.D., president and CEO of the SCAN Foundation, the other funder, called the report “a fabulous bit of research.”

The BPC report contains several recommendations that would enable providers and health plans to offer LTSS to chronically ill Medicare beneficiaries who are not eligible for full Medicaid benefits, including:

  1. Reform Medicare Advantage supplemental benefit rules to allow frail and chronically ill enrollees to receive targeted non-medical services and supports.
  2. Change Medicare's risk adjustment model to remove the financial disincentive for caring for functionally impaired patients.
  3. Develop new quality measures that will financially incentivize Medical Advantage plans and accountable care organizations to provide non-Medicare-covered social supports.
  4. Clarify anti-fraud rules to allow ACOs and medical homes to provide non-Medicare-covered supports to chronically ill patients for free.

The organization said that many of its recommendations are similar and complementary to those in the Chronic Care Act of 2017, which is pending before the Senate Finance Committee.

“In the Medicare program, federal policymakers have forever been drawing an incredibly bright line between what is considered covered medical care and the long-term services and supports that people receive that are financed by Medicaid, by private-pay and, very often, provided just by unpaid family caregivers,” said Anne Tumlinson, CEO of Anne Tumlinson Innovations and founder of Daughterhood. She moderated a panel discussion related to the report. “That made sense if you're trying to control costs in fee-for-service, but … we're rapidly moving toward a value-based care system,” she added.

The report, Tumlinson said, is “creating a pathway for policymakers to begin to take that line and make it make sense for these organizations that are taking risk for these lives at the local and community level.”

The full report can be downloaded on the BPC's website.

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