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AHCA/NCAL Responds to Senate Finance Request on Chronic Care  
AHCA/NCAL Responds to Senate Finance Request on Chronic Care
Unintended consequences should be considered, Association says
(202) 898-3165

Washington, D.C. -- The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) responded to a bipartisan Senate Finance Working Group document that explores various policy options on chronic care for Americans. The Association's comments and suggestions follow a December 18, 2015 request for input from key stakeholders on how best to increase care coordination, streamline payment systems, and improve outcomes for the millions of Americans managing chronic illnesses.
"This issue is of vital importance to AHCA/NCAL, since a majority of the individuals our members care for have multiple chronic medical conditions -- and the number is growing rapidly," said Clifton Porter II, Senior Vice President of Government Relations at AHCA/NCAL. "It's also a major cost driver. Medicare spending for beneficiaries with chronic conditions is more than $300 billion annually. Per capita Medicare spending for beneficiaries with six or more chronic conditions is three times higher than for the average beneficiary," he added.
Mike Cheek, Senior Vice President for Reimbursement Policy and Legal Affairs, said, "Much can be learned from past programs aimed at supporting persons with multiple chronic conditions. We stand ready to offer solutions to this growing challenge."
Highlights of the AHCA/NCAL comments include: 
  • In developing new policy solutions, it is essential to distinguish the subgroup of very ill individuals who account for a high percentage of Medicare spending from the much larger population of functional elders with one or two chronic diseases. The very high-cost beneficiaries with multiple chronic conditions and ­dependence upon others for care are a very different population. 
  • Any models designed for this population must go beyond addressing not only a single condition but rather a web of interrelated challenges based on multiple, interactive chronic conditions and strongly related non-medical challenges. 

  • The most successful models of care for elders with multiple chronic conditions must address more than general medical care and must have the capacity to coordinate care across several conditions as well as address social needs. 
  • The Working Group should carefully consider unintended consequences of the proposed policy options. Such unexpected impacts could interact with existing demonstrations or payment systems that already are moving from traditional fee-for-service to other methods of payment and negatively affect patient access. 
  • AHCA/NCAL is concerned with linking payment to community-level quality measures over which providers may not always have control or which put providers at odds with residents' personal health-related wishes (e.g., smoking). 
  • The Association strongly recommends that the Work Group investigate how CMS, specifically the Center for Clinical and Quality Standards, could work more closely with stakeholders and providers regarding the development and use of appropriate quality measures for this population. 
  • While the Association appreciates the efforts of CMS to modernize and innovate, it is concerned about the number and pace of changes. 
"We urge a continued careful, thoughtful, and deliberative process to ensure that final policy recommendations benefit not only those individuals with chronic medical conditions, but also the providers that support and care for them," said Porter.