Confronting The Barriers To Chronic Care Management In Medicare

Berenson, Robert A.; Horvath, Jane

doi:10.1377/hlthaff.w3.37

Cited by 64 publications

(63 citation statements)

References 6 publications

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“…Finally, there would be a serious moral hazard problem with FFS payment for e-mails; one doubts the long-term viability of a FFS payment system in which patients and doctors are text messaging back and forth while the thirdparty payer pays the bill for each interaction. 30 Under idealized market competition, primary care physician practices might theoretically provide non-reimbursed primary care activities (like enhanced access or care coordination) as "loss leaders" to attract and retain the allegiance of patients who would also seek care for reimbursable services. However, with primary care physicians in short supply-and those remaining burdened by the "treadmill" of visit-based payments-these market mechanisms do not appear to be working.…”

Section: Living Off Visits: the Traditional Economics Of Fee For Servmentioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

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The purpose of this paper is to address why the three dominant alternatives to compensating physicians (feefor-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.KEY WORDS: primary care; reimbursement; health care delivery.

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Section: Living Off Visits: the Traditional Economics Of Fee For Servmentioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

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“…1 The prevalence of chronic conditions and multimorbidity will increase and associated healthcare expenditures will continue to rise. [2][3][4] Modifiable behaviors such as at-risk alcohol consumption will need to be identified as a component of patient-centered, comprehensive primary care. Excessive alcohol use can exacerbate chronic medical conditions.…”

Section: Introductionmentioning

confidence: 99%

Drinking Patterns of Older Adults with Chronic Medical Conditions

et al. 2013

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BACKGROUND: Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population. OBJECTIVES: To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions. DESIGN/METHODS: This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims. The sample included community-dwelling, fee-for-service beneficiaries 65 years and older with one or more of seven chronic conditions (Alzheimer's disease and other senile dementia, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and stroke; n=7,422). Based on selfreported alcohol consumption, individuals were categorized as nondrinkers, within-guidelines drinkers, or at-risk drinkers (exceeds guidelines). RESULTS: Overall, 30.9 % (CI 28.0-34.1 %) of older adults with at least one of seven chronic conditions reported alcohol consumption in a typical month in the past year, and 6.9 % (CI 6.0-7.8 %) reported at-risk drinking. Older adults with higher chronic disease burdens were less likely to report alcohol consumption and at-risk drinking. CONCLUSIONS: Nearly one-third of older adults with selected chronic illnesses report drinking alcohol and almost 7 % drink in excess of National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. It is important for physicians and patients to discuss alcohol consumption as a component of chronic illness management. In cases of at-risk drinking, providers have an opportunity to provide brief intervention or to offer referrals if needed.

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“…Furthermore, PCPs do not have the time and often feel ill-prepared to provide the systematic assessments, preventive interventions, patient education, health coaching, and psychosocial follow-up required for effective chronic illness care. 11,[21][22][23][24] As a result, PCPs often refer patients with chronic illnesses to multiple providers; fragmentation of care ensues when there is inadequate communication between providers, typically because no single provider coordinates care to ensure that evidence-based guidelines are used to enhance health outcomes.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design

Allen

Hazelett

Jarjoura

et al. 2011

Population Health Management

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Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n ¼ 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers.

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Confronting The Barriers To Chronic Care Management In Medicare

Cited by 64 publications

References 6 publications

US Approaches to Physician Payment: The Deconstruction of Primary Care

US Approaches to Physician Payment: The Deconstruction of Primary Care

Drinking Patterns of Older Adults with Chronic Medical Conditions

The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design

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