Next Steps in Chronic Care

Over the last six years, the Bipartisan Policy Center’s Health Project has developed policy recommendations to improve access to services, improve quality, and lower the cost of care for those with complex care needs, including those with chronic conditions. These efforts have focused on recommendations to:

1. improve the integration of care for Medicare-Medicaid beneficiaries, or “dual-eligible” individuals;
2. improve flexibility in Medicare Advantage (MA) so that plans can target supplemental benefits to patients with multiple chronic conditions;
3. improve the availability of care at home and in the community for those with serious illness;
4. improve the financing and delivery of long-term services and supports; and
5. better integrate clinical health and behavioral health services. Congress enacted many of these recommendations as part of the Bipartisan Budget Act of 2018 (BBA), while others have been implemented through regulations or other agency guidance.

Since enactment of the BBA, BPC has monitored its implementation and hosted public events and private roundtable discussions with expert stakeholders to better understand how best to improve care for those with chronic conditions. Based on those efforts, BPC provided comments to the Centers for Medicare and Medicaid Services (CMS) on the integration of care for dual-eligible individuals and on the targeting of supplemental benefits for those with chronic conditions.

Recognizing the need to continue efforts to improve care for those with chronic conditions, this report makes recommendations in three areas:

1. Providing greater authority to CMS to integrate services for Medicare-Medicaid beneficiaries;
2. Improving on the BBA provisions allowing MA plans to offer special supplemental benefits for individuals with chronic illness; and
3. Improving care for those with chronic conditions in Medicare fee-for-service through accountable care organizations, primary care models,
   and chronic care management.