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Today, Representatives Suzan DelBene (WA-01) and Mike Kelly (PA-16) introduced the Chronic Care Management Improvement Act, bipartisan legislation that would facilitate better care management for the more than 22 million Medicare patients with two or more chronic diseases. Chronic care management has been proven to lower patient costs and improve health outcomes, but the practice remains underutilized because of Medicare’s payment structure. 

Chronic care management services are provided on the back end between providers but currently require a 20% cost-share from patients. This prevents many seniors from utilizing this service. The cost is a financial barrier, but it also confuses patients who don’t understand why they are charged for it. 

“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 incredibly impactful services. Dropping cost-sharing requirements would increase access to these services for more seniors.” 

“The Chronic Care Management Improvement Act aims to allow seniors to access important services to manage their health, free of co-pays,” said Kelly. “This bill helps doctors manage patient health behind the scenes, an essential tool in the preventative care toolbox.”

Chronic care management 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 around $12 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% of eligible 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 chronic care management services were significantly lower compared to those not receiving them. After 12 months, spending per beneficiary per month 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.). 

This bipartisan legislation has been endorsed by health provider and patient advocacy groups, including Alzheimer's Association and the Alzheimer's Impact Movement, American Academy of Family Physicians, American Association of Nurse Practitioners, American Association of Psychiatric Pharmacists, AARP, American College of Clinical Pharmacy, American College of Lifestyle Medicine, American College of Osteopathic Family Physicians, American College of Physicians, American College of Rheumatology, American Diabetes Association, American Geriatrics Society, American Hospital Association, American Medical Association, American Medical Group Association, American Osteopathic Association, American Psychiatric Association, American Society of Health-System Pharmacists, America's Essential Hospitals, America’s Physician Groups, Association of American Medical Colleges, Connected Health Initiative (CHI), Association for Competitive Technology (ACT), Cadence, Healthcare Leadership Council, Health Care Transformation Task Force, Mental Health America, Medical Group Management Association, National Alliance on Mental Illness, National Association of ACOs, National Kidney Foundation, National Patient Advocate Foundation, National Rural Health Association, Partnership to Fight Chronic Disease, Premier Inc., Primary Care Collaborative, Primary Care Development Corporation, Remote Monitoring Leadership Council, TapestryHealth, and The Alliance for Connected Care.