Dozens of provider and patient advocacy associations are putting their weight behind a newly introduced bill they say will promote better management of Medicare patients with multiple chronic conditions.
The bipartisan Chronic Care Management Improvement Act targets a copayment that beneficiaries must agree to before they may receive a slew of behind-the-scenes services coordinating their records and care across multiple provider offices.
The 20% coinsurance amount is relatively small—often around $12 a month, per the bill’s backers—but can become a financial barrier for any beneficiaries unable to shoulder additional out-of-pocket expenses. An additional monthly bill not directly tied to a medical appointment can also confuse seniors and complicate providers’ efforts to obtain needed consent for the services, legislators and supporters said.
Despite the services’ outcomes and cost-savings benefits, utilization has been low since a billable code for chronic care management was added to the 2015 Medicare Physician Fee Schedule. As of a 2022 report reviewing 2019 traditional Medicare claims, the most recent data available, 882,000 (4%) of the more than 22 million Medicare patients with two or more chronic diseases who would be eligible have received those services.
“Removing barriers to chronic care management is key to lowering healthcare costs and delivering better results for seniors,” Rep. Suzan DelBene, D-Wash., who introduced the bill in the House Tuesday with co-sponsor Rep. Mike Kelly, R-Penn., said in a release. “Chronic health conditions account for 90% of national health care spending, yet too few seniors are receiving these incredibly impactful services. Dropping cost-sharing requirements would increase access to these services for more seniors.”
The services included in chronic care management span structured recording and maintenance of patient information, document sharing during care transitions, appointment scheduling, systematic needs assessments, coordinating between clinicians and home- or community-based providers and more.
Accompanying the bill’s introduction was an endorsement letter signed by 40 healthcare and patient groups, including the American Medical Association, the Medical Group Management Association, the American Hospital Association, AARP and the National Patient Advocate Foundation.
The letter stressed that “millions of chronically ill Medicare beneficiaries stand to benefit” from chronic care management services currently underutilized due to the bill’s target barriers.
Both the endorsement letter and the release from DelBene’s office cited a 2017 analysis (PDF) commissioned by the Centers for Medicare & Medicaid Services that found savings tied to the services. Specifically, it found that monthly spending per beneficiary was $28 lower among those who had been receiving services for 12 months and $72 lower among receiving the services for 18 months.
“These services allow care teams to address more aspects of a patient’s health, thus increasing the chance of more positive outcomes,” the healthcare groups wrote in their endorsement letter. “Providers and care managers report many positive outcomes for beneficiaries who receive [chronic care management] services, including greater patient satisfaction and adherence to recommended therapies, improved clinician productivity, and reduced hospitalizations and emergency department visits.”