Medicare will Coordinate Care for Chroncially-ill Patients

Posted on: August 18th, 2014 by Mark R. Friedman

Next year, Medicare will start paying doctors to coordinate care for patients with chronic illnesses. The decision will benefit patients with two or more chronic illnesses, who account for 93 percent of Medicare spending, according to the New York Times.

Coordinated care is meant to prevent inefficiency. For example, a patient who is very sick might receive care from ten different doctors over the course of a year. With so many providers in play, important information about the patient might be lost between offices. Follow-up with the patient may also be lacking – if he has surgery to make him healthy, then goes home and neglects to take his medicine or resumes unhealthy habits like bad eating, it defeats much of the purpose of the surgery.

With coordinated care, patients can sign up to have a doctor create a comprehensive plan of care. The care coordinator might assess the patient’s social needs that are affecting health outside the hospital; check whether the patient is taking medicine as prescribed; monitor care provided by other doctors; and help the patient transition home after hospital visits.

Coordinated care will cost roughly $500 per year, with patients footing 20% of the bill. This holistic approach to care is meant to keep patients healthier while saving money for the Medicare program, by reducing patients’ need for expensive surgeries and other procedures.

It seems likely that this approach will keep patients healthier, but whether it will reduce costs for Medicare remains to be seen. In a Medicare pilot program, coordinated care was successful at keeping patients out of the hospital, reducing patient hospital visits by as much as one-third. However, in the best cases the initiative was cost-neutral and failed to save Medicare money.  Nonetheless, the government will try its hand at an approach that has already been embraced by the private sector (many private Medicare Advantage plans already offer care coordination).

It is worth noting that the concept of coordinating care for the sickest patients was pioneered in Camden, New Jersey. Dr. Jeff Brenner and the Camden Coalition of Healthcare Providers have shown that care coordination can be successful in bettering patient outcomes and reducing costs. Hopefully, Medicare will find similar success in its care coordination program.

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