Wyden calls for changes in key ObamaCare program

Wyden said Congress should instead focus on how Medicare addresses chronic diseases.

Wyden is widely respected as a health policy expert. He rankled many Democrats, though, by partnering with Rep. Paul RyanPaul Davis RyanDon't let them fool you — Republicans love regulation, too Senate harassment bill runs into opposition from House The Hill's Morning Report — Sponsored by PhRMA — The art of walking away from the deal MORE (R-Wis.) on a plan to partially privatize the Medicare program.

Wyden steered clear of such large-scale proposals on Thursday.

He proposed several changes to the structure of Accountable Care Organizations (ACOs), which are new, integrated healthcare networks created by the Affordable Care Act in an effort to lower costs by improving coordination among doctors and other providers.

ACOs are voluntary networks in which doctors, hospitals and other providers can join together to better coordinate their care for individual patients. Supporters hope the model will pave the way toward a system that pays for quality, rather than the number of services provided.

Wyden, though, said some restrictions on ACOs are holding back those goals.

He said Congress should remove a rule that requires ACOs to accept all patients who want to participate. 

The restriction was intended to prevent ACOs from cherry-picking healthy customers, leaving the people who most need an integrated healthcare system without access to one.

But Wyden said the requirement is having the opposite effect: barring doctors from creating ACOs that focus primarily on chronic conditions such as heart disease and diabetes.

"The … rule needs to be changed to allow providers to specialize in chronic care," Wyden said. "Our objective should be to make the adverse selection issue disappear by creating specific consumer protections for seniors in plans that specialize in senior chronic care while fully retaining the current protections against discrimination for all other seniors under current law."

Wyden addressed the issue during a speech the National Accountable Care Summit in Washington.

He also said the organizations are popping up in the wrong places. States where seniors are relatively healthy have more ACOs than areas where seniors are sicker and would benefit more from integrated care options.

“The Medicare guarantee should not depend on where you live,” Wyden said.

Wyden said ACOs should be able to offer incentives that encourage seniors to live healthy lifestyles and said more seniors should receive individualized care plans when they enroll in one.

"Even if you are a senior in an ACO, you may not be lucky enough to have an individual care plan, which is the centerpiece of top-quality, coordinated chronic care," Wyden said. "This is because the current ACO rule is ambiguous about who is entitled to an individual chronic care plan."