WASHINGTON, D.C. – House Ways and Means Health Subcommittee Chairman Pat Tiberi (R-OH) today delivered the following opening statement at a Subcommittee hearing entitled “Promoting Integrated and Coordinated Care for Medicare Beneficiaries.”
Remarks as prepared for delivery:
“Welcome to the Ways and Means Subcommittee on Health hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries.
“It is my pleasure to welcome our four witnesses today as we continue our discussion on the Medicare program and the different integrated-care delivery systems offered to our seniors, including those up for extension this year.
“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.
“PACE, or the ‘Program for All Inclusive Care for the Elderly’, is an integrated care program that provides hands-on, long-term care and support to beneficiaries who need an institutional level of care but continue to live at home.
“Although this program offers seniors and their caregivers a great opportunity to stay in the community and receive the care they need, the criteria for entering a PACE organization remains very restrictive. Additionally, the regulatory and administrative burdens of operating a PACE facility can often make it difficult for PACE organizations to expand and grow to serve more beneficiaries.
“Another integrated care option for vulnerable seniors is Special Needs Plans or SNPs. Congress must act by the end of this year to reauthorize SNPs in order for seniors to continue to have access. Yet, we continue to find challenges surrounding care coordination and delivery in certain types of SNPs.
“Due to the lack of integration of benefits and administrative burden of offering a SNP plan, CareSource, a managed care plan offered in my District, has delayed offering SNP plans in their current form. While continuing to offer other insurance products that serve dual-eligible beneficiaries, CareSource finds the integrated model that they are using in NE Ohio to be a better, more effective and more efficient model to serve dual-eligible beneficiaries – one that reduces provider burden and ensures the patient receives the care and supports needed to meet their total health care needs.
“Today we will hear from our panel on the benefits and challenges to PACE and SNP operations, as well as its enrollees. We will also explore different bipartisan options for changes to these key programs and others within Medicare Advantage, such as value-based insurance design, that are needed to increase efficiencies, quality, beneficiary experience and enrollment.
“As the Medicare population continues to grow, it is important that we continue to look at how we can move from volume to value-based care across all parts of the Medicare program. Today, we will hear about how allowing more plan flexibility within MA through incentivizing the use of high versus low-value care has the potential to lead to lower costs for both taxpayers and beneficiaries while also improve heath and quality outcomes.”