Expanding Care Coordination for High-Cost, High Need Beneficiaries

NCHC Writer
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In both public programs and the private sector, 5% of patients account for 50% of health care costs. These patients typically face multiple chronic conditions and functional limitations that together lead to enormous health care costs, disability, and premature mortality. Better care and services for these often-vulnerable individuals is both a fundamental moral responsibility and an indispensable element of any serious effort to curb overall health care spending.

Improve Chronic Care in Medicare Advantage and Medicare Accountable Care Organizations (ACOs)
In Medicare, meeting that responsibility means doing more to help MA plans and ACOs to improve care and lower costs – particularly for the most vulnerable patients.

  • Risk adjustment must fully account for the additional cost of caring for dually eligible, frail, or disabled beneficiaries.
  • To encourage a more robust response to the social determinants of health, Congress should remove regulatory barriers that prevent accountable entities (health plans or ACOs) from investing program dollars on behavioral health, housing, and social and long-term services and supports.

Patient-Centered Care Planning
Any patient’s or consumer’s priorities should drive the care and services they receive. When chronic disease evolves into serious or advanced illness, it is particularly critical that a patient’s own preferences and choices guide the course of treatment. NCHC supports the following improvements to the current benefits in Medicare and across our health care system:

  • Ensure that palliative care options are available and made known to patients throughout the course of illness
  • Improve care for patients with advanced illness by reimbursing for care planning and providing relief from cost-sharing for those services

Recent Publications from NCHC on this topic:

NCHC letter expressing support of & offering suggestions for key provisions of the CHRONIC Care Act – NCHC expresses support for key provisions of S. 870, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, and suggests steps to further strengthen the legislation as it moves forward

NCHC Supports Key Provisions of CHRONIC Care Act – Statement by John Rother, President & CEO of National Coalition on Health Care “People with multiple chronic conditions account for the majority of health spending, and their care is too fragmented and costly. This legislation is a promising beginning of the effort to address the problem, but certainly not the end. “NCHC applauds the Committee, its Members, […]

Care Coordination for High-Cost, High-Need Beneficiaries – Better care for these high-need individuals is an indispensable element of any serious effort to slow the growth of health care spending while improving quality.

NCHC letter in support of Independence at Home model & HR 3623 – NCHC supports the Independence at Home model and HR 3623 which extends and strengthens the current Independence at Home Practice Demonstration.

National Coalition on Health Care Presses Congress for Bipartisan Solutions in Advance of Approaching Deadlines – In a letter sent to Congressional leaders on Tuesday, September 5, the National Coalition on Health Care called for common-sense, bipartisan solutions to address the looming cuts and deadlines impacting non-group insurance, the Children’s Health Insurance Program (CHIP), primary care, and Medicare benefits and services.

After Debt Ceiling Deal, Congress Must Prevent Disruption to Nation’s Health System – Statement by John Rother, President and CEO of the National Coalition on Health Care, following House and Senate passage of legislation raising the debt ceiling, funding discretionary federal programs, and funding natural disaster relief   “With the debt ceiling deal, Congress may have averted major disruption to financial markets, but it must still act this month to […]

NCHC Commends House Committees for Advancing Bipartisan Medicare Chronic Care Bills – NCHC commends Energy and Commerce and the Ways and Means Committees for advancing bipartisan Medicare chronic care bills yesterday. These constructive home-based primary care and telehealth bills are examples of the innovative care strategies that we will need to improve the affordability and efficiency across our health care system.