A Primer on Managed Care: Multiple Chronic Conditions

Improving Care for People with Chronic Conditions By Katherine Hayes

Implementation of the Bipartisan Budget Act can potentially benefit the cohort of Medicare beneficiaries who have multiple chronic conditions.

F or the past decade, health policy discussions in Washington, D.C., have led to partisan debates over the merits of the Affordable Care Act. Since the law’s enactment, the House of Representa- tives has voted to repeal or weaken “Obamacare” so many times that there are partisan disagree- ments over the number of efforts. And any night owl C-SPAN followers will not soon forget watch- ing the late Arizona Republican Senator John McCain cast the deciding vote in the Senate, turn- ing a literal thumbs-down to his own party’s repeal-and-replace legislation. Behind the scenes, however, policy makers have become increasingly frustrated by the par- tisan divides on healthcare. That frustration, fueled by a desire to address pressing public pol- icy issues, led a handful of senators to take action on addressing policies designed to improve out- comes and lower the cost of care for Medicare beneficiaries with multiple chronic conditions. The Chronic Care Working Group, led by Sena- tors Orin Hatch (R-UT), Ron Wyden (D-OR),

Mark Warner (D-VA), and Johnny Isakson (R-GA)—with support from the House Repub- lican and Democratic Leadership—worked to include policy changes in the Bipartisan Bud- get Act of 2018 (BBA) (BBA, 2018; Bipartisan Chronic Care Working Group, 2015). The Trump Administration in 2018 used existing regulatory authority to begin these changes in 2019, with the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) finaliz- ing additional regulatory flexibility for Medi- care Advantage (MA) plans (CMS, 2018a). These changes lay the groundwork for implementation of the chronic care provisions of the BBA, which provide broader statutory authority for plans to target a wide range of benefits to people with multiple chronic conditions. Those provisions will go into effect in January 2020. Collectively, these two policy initiatives hold significant potential for improved care in the coming years, but the potential for expanding

abstract In 2018, Congress enacted legislation, the Bipartisan Budget Act, to provide flexibility to Medicare managed care plans by permitting the targeting of supplemental benefits to patients with multiple chronic conditions. This change provides an opportunity to expand care models that have been successful in improving outcomes and lowering use of medical services for people with complex needs. The law has the potential to allow Medicare beneficiaries with multiple chronic conditions and func­ tional limitations to stay in their homes longer, and success in managed care could support expansion to other Medicare payment and delivery models. | key words : Bipartisan Budget Act, Medicare Advantage, supplemental benefits

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