Wyden urges supercommittee to improve care coordination in Medicare and Medicaid

Oregon Sen. Ron Wyden's patience ran out during a hearing Wednesday on ways to improve care for the nine million people who make up a disproportionate chunk of government healthcare spending.

The federal government has been struggling for decades to improve care for the so-called "dual eligibles" who are enrolled in both Medicare and Medicaid, most of whom are low-income seniors or people with disabilities. The lack of coordination between the two programs has led to massive amounts of waste and sub-par care, prompting the Democratic senator to demand that the deficit-cutting supercommittee take up the issue.

"We have been treading water on this issue, literally, for decades," Wyden said during a Senate Finance Committee hearing. We're "about where we were three decades ago, when I had a full head of hair and rugged good looks … and we were talking about exactly the same issues."

Wyden's outburst came during a Senate Finance Committee hearing on the dual eligibles, which account for about 16 percent of Medicare enrollees but 27 percent of the program's spending. The panel heard from Melanie Bella, director of the new Medicare-Medicaid Coordination Office created by the healthcare reform law, who laid out a multi-year strategy of getting the dual eligibles into coordinated care settings.

Currently, Bella said, only about 100,000 "duals" are currently in "integrated and coordinated systems" where an entity is responsible both clinically and financially for their care. Her office's goal is to boost that number to 1 million by 2012 and to keep adding more year after year.

"We believe that the inefficiencies in care that are harming quality and driving costs in the system result from the fragmentation," she told lawmakers. "So our ultimate goal is to ensure more of our beneficiaries are served in integrated systems that coordinate all of the benefits."

To meet those goals, the Department of Health and Human Services is partnering with a number of states, which run Medicaid with federal assistance.  Bella's office has awarded $1 million grants to 15 states to design coordinated care demonstrations for dual eligibles that can be tested locally before being expanded nationally if they work.

The duals office is also inviting states to test two new payment and service delivery models — applications are due Oct. 1 — and has launched a new demonstration focused on improving the quality of care at nursing homes.

Wyden wants quicker action on a grander scale.

Along with members of both parties, he fought to get a homecare provision into the healthcare reform law; it ended up being "ratcheted down" to a demonstration involving 10,000 people. Now he's fighting for the deficit supercommittee to take up the mantle.

The demonstration uses physicians and nurse practitioners to direct primary care teams that provide certain services to Medicare beneficiaries in their own homes. Wyden wants to extend it to millions of dual eligibles.

He points to a recent Veterans Affairs report showing that the department's Home Based Primary Care program helped lower costs by 24 percent in 2002. Hospital readmissions, the report says, were 31 percent lower in 2007 with the program than without.

Wyden argues that if the program works so well for veterans, there's no reason not to expand it to dual eligibles.

"Unless there's a commitment to move aggressively," Wyden told reporters after the hearing, "as sure as night follows day people will be sitting in hearing rooms like this in a few years having the same debate."

---