Improving care for high-cost Medicare, Medicaid beneficiaries

Healthcare team of professionals

High-cost, high-need Medicare and Medicaid beneficiaries face a host of challenges when interacting with the healthcare system, but certain policy changes could improve care for these patients, according to a new fact sheet from the National Coalition on Health Care (NCHC).

The need for better policies is also pressing from a cost standpoint, as the fact sheet points out that 15 percent of Medicare enrollees who have chronic conditions and functional limitations account for 32 percent of Medicare spending.

Yet cost-saving approaches to care such as personal care assistance and nutritional services are unavailable to the majority of these beneficiaries due to current rules for Medicare Advantage (MA) plans or accountable care organizations (ACOs), according to the NCHC.

In addition, seriously ill patients encounter barriers in accessing care planning and palliative care services, and beneficiaries with mental and/or substance abuse conditions lack adequate integration of primary care and behavioral health services.

Therefore, the NCHC suggests that Congress pass legislation to allow both MA health plans and ACOs to invest program dollars in targeted social and long-term services and supports.

It also recommends that the Medicare program ensure that palliative care options are available to patients throughout the course of illness and reimburse for care planning offered to patients who are diagnosed with Alzheimer's.

Finally, it recommends a Medicaid prospective payment system for community behavioral health clinics that can coordinate and deliver both primary care and behavioral health services. Policies should also help integrate basic screening for and management of mental health and substance abuse disorders into primary care, the NCHC says.

To learn more:
- here's the fact sheet