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Senate and House Members Introduce Chronic Care Management Bill

Posted on 1/17/2014 by NTOCC ® in Public Policy Updates
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Today, Senators Ron Wyden (D-OR), Johnny Isakson (R-GA) and Representatives Erik Paulsen (R-MN) and Peter Welch (D-VT) introduced legislation that would expand the use of interdisciplinary health teams to improve care coordination for beneficiaries with multiple chronic conditions. The Better Care, Lower Cost Act encourages specialized team-based care, including case management services, with rewards for improving patient’s outcomes and use of telemedicine and knowledge networks to increase access in rural areas. Specifically, the bill creates the “Better Care Program,” allowing health plans and groups of providers to form “Better Care Plans” or “Better Care Practices,” (BCPs). This program would be voluntary and open to Medicare enrollees suffering with chronic illnesses. Participating plans and practices would receive newly calculated risk-adjusted, capitated payments rewarding better health outcomes for enrolled beneficiaries.

The Better Care, Lower Cost Act encourages specialized team-based care, including case management services, with rewards for improving patient’s outcomes and use of telemedicine and knowledge networks to increase access in rural areas.  Specifically, the bill creates the “Better Care Program,” allowing health plans and groups of providers to form “Better Care Plans” or “Better Care Practices,” (BCPs). This program would be voluntary and open to Medicare enrollees suffering with chronic illnesses. Participating plans and practices would receive newly calculated risk-adjusted, capitated payments rewarding better health outcomes for enrolled beneficiaries.  

Although similar to the idea of Accountable Care Organizations (ACOs), BPCs differ from an ACOs in several ways.  BCPs would be allowed to focus and specialize in chronic care delivery and management. Under current law, the so-called “attribution rule” strictly limits ACOs and other provider-led organizations from actively targeting and enrolling sicker patients to them with integrated chronic care services. BPCs would not be subject to this rule. In addition, although ACOs are eligible for shared savings if they reduce costs while meeting quality benchmarks, they continue to operate in a fee-for-service system. BCPs would be paid a fixed amount for each enrolled beneficiary.  

Please click here to view a full summary document of the differences between ACOs and BPCs.  Please click here for a bill summary. 
National Coalition on Health Care, the Council for Affordable Health Coverage, and AARP are among several organizations that have come out in strong support the legislation. 
 
NTOCC staff are reviewing the details of the legislation and will be holding a Policy & Advocacy Workgroup call soon to discuss NTOCC’s next steps.