Press Releases

Today, Representatives Suzan DelBene (WA-01), Jeff Duncan (SC-03), and Peter Welch (VT-At-Large) reintroduced the Seniors’ Chronic Care Management Improvement Act (H.R. 4755), bipartisan legislation that will facilitate better chronic care management (CCM) for Medicare beneficiaries. Chronic care management has been shown to meaningfully lower patient costs and results in better health outcomes but the practice remains underutilized because of the current Medicare payment structure.

CCM services are non-patient-facing but currently require a 20 percent cost-share from patients which prevents many seniors from utilizing this service.

“Removing these barriers to more widespread chronic care management will make it easier for health care providers to deliver better care to American seniors,” said DelBene. “Chronic health conditions account for 90 percent of our nation’s health care spending and this is a meaningful way to lower costs and improve health outcomes. It’s unfortunate so few seniors access this benefit and I believe dropping the cost-sharing requirements will change that.”

“With a growing national debt and aging population, Congress needs to find commonsense solutions to reduce costs for Medicare and Medicare patients,” said Duncan. “By investing a few extra dollars a month through the Seniors’ CCM Improvement Act, we ultimately save the taxpayers and seniors money while simultaneously providing a higher standard of care. Lower costs and better health outcomes are something everyone should get behind.”

“Chronic care management keeps Vermont’s seniors healthy and helps them save money. By dropping the cost-sharing requirement for these important services, this bill will help more seniors across the country get the care they need without incurring additional costs,” said Welch.

CCM is performed continuously and billed each month. While providers are required to get consent from their patients before providing these services, it is confusing to seniors to get a bill from their physician when they did not have an appointment. The coinsurance is small, usually $8 per month, but providers must comply with Medicare rules and make an honest effort to collect that payment.

Chronic care management can help improve patient outcomes but this service is sorely underutilized. Of the 35 million eligible Medicare beneficiaries, only 684,000 – less than two percent of patients – received CCM services in the first two years of the payment policy. The clear majority of patients are not benefiting from coordinated care.

A 2017 Mathematica analysis found that overall expenditures for seniors receiving CCM services were significantly lower compared to those not receiving them. After 12 months, per beneficiary per month spending saw a $28 decrease compared to those who did not receive such services. When the lookback was extended to 18 months, the savings jumped up to $72 per beneficiary per month.

Chronic care management services include:

• Recording of patient information using certified EHR technology;
• Providing 24/7 access to providers;
• Designating a team member to schedule future appointments;
• Systematic assessment of the patient’s medical, functional, and psychosocial needs;
• Medication reconciliation and adherence;
• Creation of a comprehensive care plan;
• Transmission of documents to ensure continuity of care during care transitions;
• Coordination with home and community-based providers; and
• Enhancing communication options (secure messaging, etc.).

According to the Centers for Disease Control and Prevention, over 27 percent of American adults were living with two or more chronic conditions in 2018.

A summary of the legislation can be found here. The bill text is available here.