Medicare Working on Care Model Just for the Very Sick

Medicare is developing a doctor payment model just for beneficiaries with serious, life-limiting illnesses.

There was no formal announcement, but HHS Secretary Alex Azar said last week that Medicare should test a doctor payment model for the unique care needs of the seriously ill.

A couple of medical professional groups sent models on the topic that they developed to a federal review committee. The panel passed them on to Azar to consider for implementation.

The two models—sent by the Chicago-based American Academy of Hospice and Palliative Medicine and the Washington-based Coalition to Transform Advanced Care (C-TAC)—were among the dozen alternative payment models Azar’s agency received to serve various clinicians and patient populations. Of these, Azar was most drawn to the idea of a model for the seriously ill, such as those with cancer, heart failure, or advanced dementia.

“This is the strongest response from HHS yet to a proposal,” the co-chair of C-TAC told me after viewing Azar’s comments on all the models. His group and the hospice and palliative medicine group have been collaborating with Medicare to develop one model for the seriously ill. “That we all agree is the best path forward,” he told me.

The groups told HHS in their proposals that the advanced illness population represents 25 percent of Medicare expenditures but about 3 percent of beneficiaries. These 3 percent are not well-served by the fragmented health-care system, they said.

Any future model would target those in various stages of serious illness but who aren’t eligible or willing to enroll in a hospice.

The core of the model will likely be a multidisciplinary team that will offer concurrent curative (medical) and palliative (not medical) treatment; comprehensive advance care planning; shared decision making with the patient, family, and providers; and 24/7 access to clinical support.

The idea of these alternative payment models is to get away from Medicare’s strict reimbursement requirements and allow for a flexible payment structure; in this case to support the different types of services needed by very sick patients and their caregivers.

Government movement on new projects has oft been described as glacial so it’s hard to predict when the model will be formally announced.

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