A Primer on Managed Care: Multiple Chronic Conditions

plans the services and supports that can reduce avoidable hospital and institutional care. Greater emphasis on primary and preven- tive care in the home . We must expand upon the redirection of medical resources to primary and preventive care in the home setting for peo- ple with chronic conditions to minimize the development of more complex care needs and reduce the use of specialized and institutional medical care. Redesign of Medicare prescription drug coverage for chronic conditions. We need to design a benefit that ensures consistent and con- tinuous drug coverage and lessens out-of-pocket exposure for beneficiaries with long-term drug regimens. Newly launched prescription drugs should be priced to value, taking into account patients’ achieved outcomes. Greater effort should be focused on increasing medication adherence to improve outcomes and the overall value of drug treatment. Conclusion The CHRONIC Care Act marks the start of an important shift in congressional aims and health system orientation for the population most dependent upon, and most costly to, the Medi- care program and the health system as a whole. With this Act, the Congress begins to move federal investment toward building home- and community-based support for individuals with chronic conditions and complex care needs. The Act is a toe-in-the-water. It puts in place new, and potentially significant, Medicare initia-

tives to improve care for those who are covered by Medicaid and for people with similar needs who possess resources too substantial to qualify for Medicaid. The unifying feature in these initiatives is their focus on preventing medical events and improving outcomes for individuals with mul- tiple chronic conditions. But, as we know, it is not just about treating health conditions: it is as much a matter of assisting with activities nec- essary for daily functioning and ensuring indi- In-home care needs to become more affordable and practical as an alternative to institutional care. viduals with chronic conditions can remain in their homes and communities for as long as possible. These new initiatives show promise for im­ proving outcomes and afford an opportunity to test new approaches that could be scaled in the future to address much larger and more chal- lenging unmet needs for LTSS financing. G. Lawrence Atkins, Ph.D., is executive director of the Long-Term Quality Alliance in Washington, D.C., and a board member and immediate past president of the National Academy of Social Insurance. Andrew L. MacPherson is principal at Healthsperien in Wash­ ington, D.C., and a senior policy advisor to the Coalition to Transform Advanced Care and the National Partnership for Hospice Innovation.

References Bipartisan Policy Center. 2018. “Improving Care and Lowering Costs for Chronic Care Benefi- ciaries: Implementing the Bipar- tisan Budget Act.” y8sse6ng. Retrieved November 29, 2018.

Lester, R. S., and Chelminsky, D. 2018. “Using CMS Data to Under- stand D-SNP Market Trends and Performance, Dual Eligible Char- acteristics, and State Medicaid Managed Care Programs.” Slide presentation by Mathematica Pol- icy Research to the 2018 SNP Alli- ance Executive Roundtable, Wash- ington, D.C., March 27.

Tumlinson. A. 2018. “Functional Impairment a Key Factor in High Medical Spending.” Anne Tum- linson Innovations. y7bsxmov. Retrieved December 13, 2018.

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