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Congress Set to Decide on the Fate of Patient Cost Responsibility for Chronic Care Management

(Greenville, South Carolina) - July 15, 2019 - The U.S. House Ways and Means Committee has sent a bill to The U.S. House of Representatives impacting the future of care that Medicare patients in America will receive.  The Seniors’ Chronic Care Management Improvement Act (H.R. 3436) would eliminate out-of-pocket expenses seniors pay to have access to care coordination services.

The Centers for Medicare and Medicaid Services (CMS) created the Chronic Care Management (CCM) program as a care coordination model that benefits Medicare patients by keeping them out of the hospital and emergency department. The program provides chronically ill Medicare patients with non-face-to-face (telephonic or electronic) care coordination services such as assistance with prescriptions and appointments, support in adhering to the care goals established with their doctor, as well as social health determinants assistance, such as transportation or financial assistance for healthcare needs.

However, practices and vendors who provide CCM face an enormous hurdle when it comes to enrolling patients into the program, due to the monthly required patient coinsurance burden. With a majority of CCM eligible patients on a fixed income, patients are often unable to afford the required coinsurance, forcing them to choose necessities such as food or utilities.

The required coinsurance is depriving patients who cannot afford a monthly CCM bill. According to Medicare claims data, CCM reduces unnecessary hospital visits by 4.7%¹ , ED visits by 2.3%² , and manages health problems with an extra level of care. In turn, patients are healthier, more connected, and save on healthcare costs annually.

The effectiveness of the CCM program saves Medicare approximately $74 per patient, per month.³ Removing the patient cost burden would positively affect 72%⁴ of the Medicare population living with chronic conditions, and could save medicare nearly $3,700,000,000 per year in costs.

“Removing the copay for chronic care management services is a common sense action Congress can take that will make it easier for doctors and nurses to provide care coordination for their sickest patients. Chronic conditions account for 90 percent of our nation’s health care spending and this is a meaningful way to address that. I look forward to having this measure voted on by the full House of Representatives,” said Rep. Suzan DelBene, a co-sponsor of the bill.

Jon-Michial Carter, CEO of ChartSpan, the largest CCM managed service provider in the U.S., commented, “We know there are significant obstacles to getting the bill approved and through Congress, but not supporting this bill shows a lack of support for America’s senior population. The CCM program reduces costs for taxpayers and patients. Everyone wins. We encourage healthcare providers and patients across the country to get involved and ask their Congressional representative to support this bill.”

Individuals interested in taking a role in supporting this legislation can find and contact their local representative via https://clerk.house.gov/Members#MemberProfiles or by calling the U.S. House switchboard operator at (202) 224-3121.

¹ Mathematic Policy Research. November 2, 2017. Evaluation of the Diffusion and Impact of Chronic Care Management (CCM) Services: Final Report. Retrieved from https://innovation.cms.gov/files/reports/chronic-care-mngmt-finalevalrpt.pdf.

² Health Care Cost Institute. January 2018. 2016 Health Care Cost and Utilization Report. Retrieved from https://innovation.cms.gov/files/reports/chronic-care-mngmt-finalevalrpt.pdf.

³ Administration of Community Living. May 31, 2017. Developing the Business Case for Outsourcing Care Management to a Community Based Organization (CBO). Retrieved from https://acl.gov/sites/default/files/programs/2017-12/TIM%20TALKS_Business%20Planning_Care%20Management_May%2031_2017.pdf

⁴$74 is saved by medicare for patients who have been in the program for at least 12 months.