Coordinated Care for the Sickest Medicare Patients

Press Release

Representatives Cathy McMorris Rodgers (WA-05), John Larson (CT-01), Tom Reed (NY-23), and Kurt Schrader (OR-05) introduced legislation to explore how Medicare can better treat the most complex patients.

H.R. 3244, the Providing Innovative Care for Complex Cases Demonstration Act of 2015, provides complex patients with high-quality, highly-coordinated care. These plans provide far more flexibility and breadth of coverage than traditional Medicare plans and will lead to better health. It incentivizes collaboration among payers and providers and focuses on integrated approaches that improve quality and patient outcomes and experience. The result is higher quality care and lower costs.

"We've seen in many instances that coordinated care programs provide patients with better care, while reducing costs," said ​Congressman Schrader. "This innovative program will provide seniors with a new avenue to receive high quality care, tailored to their specific needs, at a lower cost, through the Medicare system. This bipartisan effort is a pragmatic approach to improving Medicare so it better serves beneficiaries."

"This common sense, bipartisan legislation creates a coordinated care program for the sickest Medicare patients," said ​Congresswoman McMorris Rodgers. "It will lead to better health outcomes for those patients and make the system more efficient overall."

"When it comes to healthcare, no one should slip through the cracks," said ​Congressman Larson. "This bill will provide many of our most vulnerable Americans access to a state of the art plan to coordinate their care, provide access to best in class providers, and cover services not typically available through Medicare--all while reducing costs to our health care system. It's crucial that we come together to make improvements to our healthcare system in a bipartisan manner. I commend Rep. McMorris Rodgers for her leadership, as well as my colleagues Rep. Schrader and Rep. Reed. This is an innovative approach to providing the best possible care for Medicare beneficiaries with chronic health conditions."

"I care about the quality of life for our senior citizens and this bill will help improve their lives in the long run," said ​Congressman Reed. "As the cost of medical care continues to increase, it's only fair that we begin looking for solutions to ensure the seniors who need care the most get the best possible, patient-centered care without cutting corners."

In 2010, the costliest 10 percent of Medicare beneficiaries accounted for almost 60 percent of annual fee-for-service (FFS) spending. This population is more likely to have chronic conditions, such as chronic kidney disease, heart failure, and chronic obstructive pulmonary disorder (COPD), while more than half (51 percent) have five or more comorbid conditions. This population is also more likely to be dually eligible for both Medicare and Medicaid.

Right now these beneficiaries are on their own to navigate the health care system. In the proposed program, each beneficiary would be served by an interdisciplinary care management team and a dedicated health professional to ensure they are getting the right care they need at the right time.

In this program patients will have more benefits, lower out-of-pocket costs, high quality standards, enrollment and beneficiary protections, risk adjustment, and an integrated care model.

Source