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Today, Representatives Suzan DelBene (WA-01) and Jeff Duncan (SC-03) introduced the Chronic Care Management Improvement Act (H.R. 2829), bipartisan legislation that will facilitate better chronic care management (CCM) for the more than 22 million Medicare beneficiaries with chronic diseases. Chronic care management has been shown to meaningfully lower patient costs and improve 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. The cost-share acts as a financial barrier but also confuses patients who don’t understand why they are charged for non-face-to-face care management. 

“Removing barriers to chronic care management is key to lowering health care costs and delivering better results for seniors,” said DelBene. “Chronic health conditions account for 90% of national health care spending, yet too few seniors are receiving these vital services. Dropping cost-sharing requirements would increase access to these services for more seniors.” 

“Chronic care management is a meaningful, commonsense way to lower patient costs and is a conservative solution to provide a higher standard of care for seniors with chronic care needs,” said Duncan. “As our national debt grows and our population ages, investing in the Chronic Care Management Improvement Act will ultimately save money for both seniors and the American taxpayer.” 

CCM services are performed continuously and billed each month. While providers are required to get consent from their patients before providing these services, it is confusing for 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 improve patient outcomes but these services are sorely underutilized. Only 882,000 – or 4 percent of patients – have received these services according to the latest data. The vast 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.