To do this, Wyden said the attribution rule under the Patient Protection and Affordable Care Act should be changed. ACOs, he said, are required to “serve everyone coming through the door,” which is intended to prevent them from avoiding expensive patients but has hindered ACOs from specializing in coordinating care for chronic conditions.
“Our objective should be to make the adverse selection issue disappear, by creating specific consumer protections for seniors in plans that specialize in senior chronic care, while fully retaining the current protections against discrimination for all other seniors under the current law,” Wyden said.
Wyden, a member of the Senate's Special Committee on Aging, also said there is gap in where ACOs are now and where the highest numbers of the nation's sickest seniors live. For instance, he said ACOs are not being established in Alabama—home to many seniors with poor health—but seniors in Massachusetts have access to six Medicare ACOs.
Medicare reimbursement, he said, should be reconfigured to target areas with the highest incidence of chronic illness, and reward practitioners in those areas who improve care and keep costs down.
Meanwhile, individual care plans should be the rule, not the exception, for seniors who have more than one chronic condition, Wyden said. And incentives should be available to help keep seniors healthy.
The Oregon Democrat—No. 44 on Modern Healthcare's 2012 list of the 100 Most Influential People in Healthcare—cited examples of success stories throughout the country where providers are making strides in improving care for patients with chronic conditions, including Dr. Ken Coburn of Health Quality Partners in Doylestown, Pa., also a conference speaker. Health Quality Partners began as a demonstration project to promote better chronic care for the elderly more than 10 years ago, Wyden said. Since then, hospitalizations have dropped by 39% and net healthcare costs fell by 28%, while mortality rates decreased by more than 25%.
“Unfortunately, our government has not given Dr. Coburn the green light to expand and tap the program's full potential,” Wyden said. “For example, the government has limited his ability to grow the program on the ground that it's just a demonstration project,” he continued. “It seems to me, the whole point of demonstrations is to let the successful efforts grow and serve more people.”
Wyden said he plans to work with colleagues from both political parties in the months ahead to develop his proposals into legislation. “These ideas,” he said, “will protect the sacred guarantee that is Medicare and help tackle one major force behind America's debt and deficit.”
Health policy and industry officials said Wyden correctly identified critical issues to evolving accountable care organizations.
Wyden's proposals seek to address important challenges under the Affordable Care Act, said Dr. Elliott Fisher, director, of the Dartmouth Institute for Health Policy and Clinical Practice. Now policymakers and the industry must identify the best technical approach to tackle them.
“People recognize that patient engagement is absolutely crucial to a prevention-oriented, patient-centered health system,” said Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution and former CMS administrator. McClellan, a proponent of accountable care, said Wyden's proposals raised important issues and that revisions to Medicare's accountable care rules and terms are likely as officials learn from early results.
Michael Murphy, senior vice president for population health strategies of UnityPoint Health, praised Wyden's push to promote chronic disease management and called incentives for healthy behavior—one of Wyden's proposals—critical to better disease management.
Rules should recognize providers that invest to coordinate care for costly, chronically ill patients and reward those that succeed, said Dr. Jeffrey Bailet, executive vice president of Aurora Health Care and president of the Aurora Medical Group.
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