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Expanding Care Coordination for High-Cost, High Need Beneficiaries

NCHC Writers Update at May 20, 2023

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