Health Quality Partners (HQP) Blog

Health reform legislation has passed.  Massive and critical work now lies ahead.  The stakes for the federal agencies called upon to administer and regulate the new health care reforms have never been higher.  Whether you agree with some, all, or none of what is in the new reform, it is clear that much hinges on the effectiveness with which our federal agencies can execute on its provisions.  What may seem like an appealing policy on paper can be an enormous challenge to translate into rules, regulations, pilots, demonstrations, etc. with potential benefits undone by bureaucratic delay or inept implementation – leading to loss of time, money and opportunity for all Americans.  This is an enormous set of tasks and expectations to place upon our federal agencies.  But they are essential for the success of health reform.  To underestimate their importance is to undercut the possible benefits of the new reform – right from the start.  Every effort must be made to ensure that key agencies have the resources they need to do the job well, especially the requisite leadership, talent, and skills to meet this daunting challenge and to implement these important new initiatives.

In a masterful review of the extensive literature related to research done on new models of comprehensive care for chronically ill older adults, Chad Boult, MD, MPH, MBA et al, describe over 15 models supported by 123 publications – proof that there is plenty out there with real promise to improve our care to this population.  The authors’ conclusion that it is time to move deliberately to build on these initial successes by moving them (thoughtfully) into broader use is a clarion call to action.  While none of these models or programs are perfect, we need to deploy them more broadly to improve care to this population, learn how to improve the models further, test their real-world replicability, and see what their potential is for dissemination.  The authors conclude by encouraging the lessening of barriers within the Medicare program to advance these aims.

While coming a bit more from the ‘glass half-empty’ perspective regarding the efficacy of current models, the article ‘What can we do to improve chronic disease care?” by Robert L. Kane, MD in the same issue of the Journal of the American Geriatrics Society also raises several important points.  Moving forward we would do well to consider the details that could make these models work better, including understanding the specificity of matching a patient to an individualized chronic care modality appropriate to their needs and congruent with their readiness and preferences for such engagement.  Targeting those within the larger population of the chronically ill most likely to benefit from and willing to engage such interventions makes practical sense.

Finally, the editorial comments by David B. Reuben, MD related to both these articles in his piece, “Better ways to care for older persons: is anybody listening?” highlight the need to have more vigorous, creative, and timely action from CMS and the Medicare program to move the most promising programs forward more aggressively.  Making all the necessary big changes to program evaluation and selection decision-making, professional culture, and reimbursement mechanisms that we need to, along the way.

As the New Year begins with hopes of new and better things ahead, a critical challenge faces CMS and the millions of Americans in the Medicare program– learning how to harness innovations in care delivery on behalf of Medicare beneficiaries. Each day several million Americans who are ‘higher-risk’ older adults with chronic conditions could be benefitting from a model like HQP’s.  Yet, despite its durable effectiveness in a rigorous, long-running, randomized trial, it is not clear how CMS plans to transition a program like HQP’s from promising innovation at a single site within a demonstration, to progressively greater opportunities for replication and dissemination.  Though Congress has given it the authority to do so it is unknown how CMS might go about it.  While the task is far from easy, it is imperative for the future of Medicare.

This is a truly pivotal question.  Discovering new innovative models that are effective, within the many, many demonstrations, projects, and pilots in the current health reform legislation, will do us little good, if when a new approach is found to be beneficial, CMS is unable to find ways to expand its use without significant delay – time being something that neither beneficiaries nor the financial solvency of Medicare can afford to waste.  Perhaps the creation of a Center for Medicare and Medicaid Innovation within CMS as described in the Senate health reform legislation will help, but it may not.  It might be that greater partnering with providers designing and implementing successful new models, public accountability, transparency, a sense of urgency about moving promising innovations into broader use, and clear objectives for doing so will be needed.

After more than 2 years of hard work on both sides, HQP and Aetna have reached an agreement to provide HQP’s community-based nurse care management to certain Medicare Advantage members with chronic illness. The service will be
available to eligible members of participating practices in a region of eastern Pennsylvania.

We are excited to have the opportunity to replicate our success in the Medicare Coordinated Care Demonstration with Aetna members and look forward to working with our colleagues at Aetna.