Helping with Complex Care Needs

Beginning January 2020, Medicare Advantage plans will offer a broad range of new non-medical benefits such as food, housing, and transportation to people with complex care needs. At a briefing held July 24, 2019, the Bipartisan Policy Center released a report offering ideas and recommendations on expanding Medicare benefits to help care for people with complex needs related to chronic conditions in the senior population.

Opening the briefing, Bill Hoagland, Senior Vice President of the Bipartisan Policy Center announced the release of the new report, “Next Steps in Chronic Care: Expanding Innovative Medicare Benefits” produced by BPC with support from The Commonwealth Fund and The Scan Foundation.

Aparna Higgins, Founder and CEO, for Ananya Health Innovations discussed how the “Long Term Quality Alliance” set up a working group with national experts totally familiar with Medicare Advantage. The working group developed the report “Guiding Principles for New Flexibility under Special Supplemental Benefits for the Chronically Ill.” (SSBCI).

BPC contracted with Ananya Health to help define Medicare patient cohorts that could potentially be eligible for SSBCIs. Eleven chronic conditions were identified such as CHF, depression, diabetes, emphysema, asthma or COPD, Alzheimer’s disease or other diagnosis of dementia, osteoporosis, other heart conditions, paralysis, Parkinson’s disease, rheumatoid arthritis, and stroke. BPC defined eligible individuals as Medicare beneficiaries with two or more of these conditions and one or more functional limitations in dealing with the activities of daily living.

The report discusses non-medical benefits, such as home-delivered meals tailored to a targeted group of individuals with chronic conditions, that could help avert hospital readmissions plus support other innovative benefits for people with chronic conditions in Medicare-Fee-For-Service.

Bruce Chernof, President and CEO, The SCAN Foundation talked about how the passage of the Chronic Care Act acknowledges the home-based services updates by allowing Medicare Advantage Plans to pay for services that are not primarily health related.

Melinda Vice President and Director, Delivery System Reform for The Commonwealth Fund reports that the Fund is working with other foundations to find ways to reduce healthcare costs for Medicare beneficiaries not only for their      health needs but also their social needs hopefully to reduce the burden of providing care.

Katherine Hayes, BPC Health Policy Director, told the attendees, “Three in four Americans over 65 are living with multiple chronic conditions. BPC is working on a value-based payment report, to discuss the challenges and policy changes needed to improve Medicare.”

A panel discussion led and moderated by Marilyn Serafini, the Director of the Health Project at BPC, provided ideas and thoughts on how people with chronic conditions in Medicare Fee-For-Services should receive care.

Panelists included:


Ideas that shared included finding ways for state agencies to deal with cost sharing, providing ways for insurance companies and providers to interact, determining how to collect data to accurately link benefits, needs, and resources, and determining how to use innovation to update technology so medical services could effectively meet the needs of seniors with chronic complex health and medical needs.

The BPC report makes recommendations to provide greater authority to CMS to help integrate and align services for people eligible for both Medicare and Medicaid. The report also offers proposals to improve on the provisions in the Bipartisan Budget Act of 2018 (BBA) so as to create more transparency around those who qualify for special supplemental benefits.

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