On Tuesday, the Senate voted unanimously to pass S. 870, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. Sponsored by Senators Orrin Hatch (R-UT), Ron Wyden (D-OR), Johnny Isakson (R-GA) and Mark Warner (D-VA), the bill addresses Medicare through traditional fee-for-service, Medicare Advantage (MA) and Accountable Care Organizations (ACOs) and includes language that would expand the testing of the value-based insurance design (VBID) model, of which NAHU has long advocated. VBID provisions in this bill would allow greater flexibility for an MA plan to meet the needs of chronically ill enrollees by tailoring coordination and benefits to specific patient groups instead of the required uniform benefits.
The bill provides for greater flexibility within Medicare, including easing telemedicine restrictions and changing beneficiary assignment to ACOs. The bill allows Medicare to pay for remote stroke diagnosis and treatment, ACOs to provide telemedicine, MA to offer telemedicine as a supplemental benefit, and for home dialysis treatment through telemedicine. Patients can be assigned to an ACO at the beginning of the year and would be eligible to receive $20 to receive certain primary care services. It would also extend the Independence at Home demonstration for two years, increase the program’s cap from 10,000 to 15,000 beneficiaries, and permanently authorize dual-eligible special needs plans (SNP), chronic condition SNPs and institutional SNPs, if certain requirements are met.
Section 301 of the bill includes language that would expand the testing of the Innovation Center’s VBID model, which allows greater flexibility for an MA plan to meet the needs of chronically ill enrollees by tailoring coordination and benefits to specific patient groups instead of the required uniform benefits. MA plans in any state would be allowed to participate in this model by 2020 (during the testing phase) to determine whether savings are achieved without negatively impacting quality. The VBID model is designed to reduce copayments or coinsurance and encourage patients to take the small, low-cost steps to manage their chronic conditions. The expectation of the demonstration is that by reducing the expenses to Medicare beneficiaries for selected high-value prescription medications and clinical services, that it will help stave off the need for much more expensive or catastrophic care and ultimately improve clinical outcomes and lower healthcare expenditures.
NAHU has long advocated for implementing VBID principles. In 2015, the House passed H.R. 2570, NAHU-supported legislation to establish a demonstration program requiring the utilization of VBID for MA for beneficiaries with chronic clinical conditions. This would help encourage individuals to treat their conditions on a proactive basis with low-cost care management, such as improving access to insulin for diabetics or beta blockers for those with heart disease. They would have lower copayments or coinsurance to use specific evidence-based care approaches; however, it would prohibit plans from increasing copayments or coinsurance to discourage services. The demonstration project would have required an independent review, upon which, if it has lowered costs and improved quality, it could be expanded throughout all MA plans.
VBID principles were also incorporated into the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA), which replaced the Sustainable Growth Rate (SGR) formula that was effectively never implemented. That act sets forth the new payment models for physicians as well as changes to ACOs and quality and value measures. It consolidates the Physician-Quality Reporting System, the Physician Value-based Payment Modifier and the Medicare EHR Incentive Program for eligible professionals, and would measure physicians in quality, cost, technology use and practice improvement.
The bill will next head to the House for consideration, although it is unclear when this will happen or how they will proceed on this or similar legislation. An earlier version of the CHRONIC Care Act had previously been introduced in December 2016. Senator Hatch, the bill’s primary sponsor, said that “The CHRONIC Care Act is one of the few bipartisan healthcare bills to pass the Senate this Congress, and I urge my colleagues in the House to act quickly on this legislation and get it to the president's desk to be signed into law." A section-by-section summary of the bill can be found here, and a one-page summary of can be found here.