In February 2018, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (CCA) was passed by Congress and signed by President Trump, making significant policy changes to advance the goals of integrated, person-centered care for adults with complex needs. The SCAN Foundation recently released a policy brief summarizing the new law.

I’m excited about the possibilities this new law creates. I believe it offers managed care organizations new incentives and encouragement to invest in interventions that will improve care delivery for high cost, high need older adults and their families. Here’s how and why.

1. It Creates More Predictability for Special Needs Plan Offerings.

How: Health plan and provider organizations offering Medicare Advantage Special Needs Plans (SNPs) no longer need to worry about operating under temporary extensions of this program. SNPs, which allow insurers to target and enroll special, high need populations, such as individuals who are dually enrolled in both Medicare and Medicaid (Dual-eligible Special Needs Plans (D-SNPs)), are now a permanent part of the Medicare program.

Why: Prior to the CCA, Congress reauthorized the SNP program seven times, each time pushing out the program’s expiration date. By making SNPs permanent, the CCA eliminates any concerns that the program might end, instilling confidence that investments will produce predictable returns.

2. It Creates More Flexibility to Manage High Cost Care.

How: Health plans now have the flexibility to offer nonmedical benefits that could help prevent high healthcare utilization. By offering nonmedical services, such as meals, wheelchair ramps, and transportation to medical appointments, health plans can better address individualized needs that often result in expensive facility-based care. This provision offers a new set of tools that will be particularly helpful to special needs plans managing the care of individuals living in the community with institutional levels of need (I-SNPs) and individuals with chronic conditions (C-SNPs).

Why: Prior to the CCA, Medicare rules prohibited health plans from funding nonmedical programs that could reduce healthcare utilization. Health plans complained that the inflexibility meant they couldn’t manage care for individuals for whom the traditional Medicare benefit package was insufficient.

3. It Holds Plans Accountable for Better Care Integration

How: The CCA does a number of things to promote better care integration, particularly in D-SNPs (the plans that serve individuals enrolled in both Medicare and Medicaid, also known as “dual eligibles”). For example, the CCA formalized the Medicare-Medicaid Coordination Office as the dedicated point of contact for states; it also presents D-SNPs with different options for integrating Medicare and Medicaid long-term services and supports and/or behavioral health services. Both MedPAC and the Government Accountability Office (GAO) will study and report to Congress on quality and integration efforts outlined in the CCA.

Why: Despite enrollment in D-SNPs, many dual eligibles still experience fragmented care. The goal is to provide D-SNP enrollees with the experience of getting their Medicare and Medicaid benefits from one unified organization, and the law provides several avenues for achieving this goal.

Moving Forward

Our greatest opportunity and challenge is to support the kind of rapid innovation and disruption that will help us prepare for a much older and frailer society. In the past, health insurers have excelled at collecting premiums, paying claims, negotiating rates, and executing contracts. However, as Medicare managed care enrollment continues to increase, the Medicare program and its beneficiaries need health plans to step up and better coordinate and manage care for their enrollees, especially those with complex care needs. The CCA takes a very important step toward encouraging them to do so.

For more information on improving care delivery for high cost, high need older adults, contact us at info@AnneTumlinson.com.