Today, the Ways and Means Health Subcommittee, chaired by Rep. Pat Tiberi (R-OH), held a hearing about how to improve the delivery and design of Medicare programs to better serve beneficiaries – especially elderly patients who are living in poverty or with a chronic illness. Members examined specific, targeted programs – such as Special Needs Plans (SNP) and Programs of All-Inclusive Care for the Elderly (PACE) – and discussed how value-based insurance design can strengthen Medicare Advantage (MA) programs by delivering quality, coordinated care to patients while reducing health care costs.
As Chairman Tiberi noted:
“The Committee continues to look for ways to reform Medicare and improve the delivery of care for seniors and people living with disabilities. I think a good place to start is to look at some of the lessons learned from smaller programs that offer targeted, coordinated care to some of the frailest and sickest beneficiaries in the Medicare program. Today is a great opportunity for us to hear about some of the impediments to providing value-driven care for this population and hear solutions that not only benefit seniors but taxpayers as well.”
Members of both parties agreed on the importance of programs that deliver coordinated care to low-income, sick, and elderly patients – not only because it reduces costs for beneficiaries and taxpayers, but also because it helps improve the health of seniors and individuals with disabilities.
As Dr. Mark Fendrick, the Director of the University of Michigan Center for Value–Based Insurance Design said:
“I believe that the primary goal of the Medicare program is to improve the health of its members, not to save money. Thus, the focus of our discussions should change from how much we spend to how well we spend our limited health care dollars.”
SNP is designed to lower costs and improve quality for beneficiaries who require more expensive care, including those who are dually eligible for Medicare and Medicaid, or living with a disabling chronic condition. As Dr. David Grabowski from Harvard Medical School explained, this program “has the potential to financially and clinically integrate services” to deliver more streamlined care for beneficiaries.
The CEO of the National PACE Association, Cheryl Wilson, described how another program, PACE, spends its resources to care for seniors. She said:
“When individuals with chronic and medically complex conditions do not have access to care, their quality of life is diminished, which over time leads to increased expenditures. PACE deliberately was constructed to address the chronic care needs of individuals by providing timely and clinically appropriate treatments and social supports. Access to care in PACE results in our participants not only experiencing a higher quality of life, but also having medical outcomes meeting the highest standards. Moreover, by reducing the incidence of complications associated with chronic illness, PACE programs also reduce the high costs of specialists, emergency rooms, and hospitals incurred in response to these complications.”
Dr. Fendrick agreed, emphasizing the need for programs that deliver personalized care:
“Going back to 1965, there was this important issue to make sure that every Medicare beneficiary had the same benefit design. I would argue, in 2017 and beyond … that instead of blunt instruments, a much better approach would be one that is individualized, similar to the situation that we heard in the PACE programs.”
“Does it make sense to you, Mr. Chairman, that my MA patients pay the same copayment to see a cardiologist after a heart attack, to see a dermatologist for mild acne, or pay the same prescription drug copayment for a lifesaving drug that treats diabetes, cancer, or depression, as one that makes toenail fungus go away?”
Thanking the witnesses, Chairman Tiberi said at the end of the discussion:
“You’ve really helped bring along the debate as we move to make Medicare more efficient, both for taxpayers and for the patients.”
CLICK HERE for more information about today’s hearing.