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Yes, we can put chronic patients first and lower costs simultaneously

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Our health-care system can be overwhelming for those of us in the best of health. This is especially true of those living with serious and life-threatening illnesses, such as cancer or heart disease — who are juggling multiple doctors, diagnoses, treatment regimens and social stressors. Patients cycle in and out of hospitals and nursing facilities, yet 80 percent say they would rather be at home as they approach the end-of-life.

Compared to other nations, U.S. health care providers rely more heavily on medical services and procedures than providing less costly services that can help patients remain more independent and at home, but that is beginning to change.

{mosads}States like Tennessee are beginning to recognize the importance of improving care for patients with advanced illness. Last month the Tennessee general assembly passed a law establishing the Palliative Care and Quality of Life Advisory Council, a recommendation of a state-level task force earlier this year.


It will help educate providers and the public, identify barriers to access, and develop best practice standards to improve palliative care quality across the state. We are seeing changes at the federal level as well, which is important since most of those with advanced illness have Medicare as their primary insurance.

Earlier this year, the Bipartisan Budget Act of 2018 made changes in the Medicare program, allowing Medicare’s managed care plans — Medicare Advantage — to provide additional services that have proven effective in improving quality of care and lowering costs, including non-medical services for patients with serious illness.

For example, a patient may have a goal of remaining in their home, but they don’t have the resources to make minor home modifications, such as handrails, ramps, or widening a doorway to accommodate a wheelchair. Another with heart disease and diabetes could receive home-delivered meals to make sure that they don’t get too much salt or sugar in their diets — a significant concern if they are living on frozen microwavable meals. 

A second opportunity may soon be available for patients who are enrolled in traditional Medicare fee-for-service plans. Last week, a panel of experts convened by the U.S. Department of Health and Human Services formally recommended two new health-care payment and delivery models be tested in Medicare to support patients living with serious or advanced illness.

These evidence-based models embrace a patient-and-family centered approach to coordinating care, and are championed by the American Academy of Hospice and Palliative Medicine and the Coalition to Transform Advanced Care. For those who are facing terminal illness, they will no longer have to choose between getting comfort or “palliative” care and treating their illness or disease.

Although the expert panel has recommended testing of these care models, the Secretary of the Department of Health and Human Services is not required to do so. One provides a monthly payment to a primary care provider for the improved coordination of care for Medicare beneficiaries. The other, while similar, specifically allows for palliative care teams to deliver community-based palliative care to patients.

These models would allow for the delivery of community-based services specific to high-need patients who are not yet eligible for or ready for hospice services. The new payment approach would seek to end the revolving door of hospitalizations for those with advanced illness, avoid unwanted treatments that aren’t in line with the patient’s wishes, allow the patient to live and receive care in the setting that’s most comfortable to him or her, typically the home; and make sure that the patient and family are listened to, and their care goals are being met.

We understand that the Centers for Medicare and Medicaid Services is working to combine these models and move forward, and we strongly support this approach. As policymakers seek ways to pay for value over volume in our health-care system, we must consider new approaches for an aging population. 

Many in Congress and the administration have worked to test and expand payment and delivery models that better reflect patient and family needs. They have done this by providing additional flexibility to Medicare Advantage plans and testing new approaches in Medicare fee-for-service will help improve quality, value and better reflect the services needed by patients with serious illness. 

Former Sen. Bill Frist, M.D. (R-Tenn.) is a former U.S. Senate majority leader. Frist is a nationally recognized heart and lung transplant surgeon and co-chair of the Bipartisan Policy Center’s Future of Health Care Initiative. Find him on Twitter as @bfrist. Former Sen. Tom Daschle (R-S.D.) is a former U.S. Senate majority leader. He is the founder and CEO of The Daschle Group and co-chair of the Bipartisan Policy Center’s Future of Health Care Initiative. Find him on Twitter as @TomDaschle.

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