The U.S. Department of Health and Human Services released a report on December 14 outlining strategies to improve care for individuals with multiple chronic conditions, such as heart disease, hypertension, diabetes, respiratory conditions, mental illness, dementia, and developmental disabilities. The report (at www.hhs.gov/ash/initiatives/mcc/mcc_framework) cites research showing that, as the number of chronic conditions in an individual increases, the patient faces greater risks of unnecessary hospitalizations, duplicative tests, adverse drug reactions, and conflicting medical advice that can be overwhelming to the patient and family members. It notes that individuals with multiple chronic conditions account for 66 percent of total health care spending in the United States and that the cost of their care is a key factor driving the nationwide growth in Medicare and Medicaid expenditures. It acknowledges that not enough attention has been devoted to the services and supports that will be needed to meet the long term needs of these individuals and to help them to live in community settings whenever they can. It also acknowledges that current Medicare, Medicaid, and commercial fee-for-service reimbursement methods rarely provide adequate financial incentives to coordinate care for these individuals and that achieving better coordination of care often requires wide access to health information technology that can bring together online all primary, specialty, and institutional caregivers involved in the patient’s treatment. National goals described in the report include promoting the use of proven self-care management methods by individuals with multiple chronic conditions, promoting the use of better care management methods by health care and social service workers, and encouraging states to consider new Medicaid options under the Affordable Care Act (ACA), such as the state plan option for coverage of health homes at a 90 percent federal medical assistance percentage (FMAP) that becomes available on January 1, 2011. PCG is providing assistance to its state clients regarding these options.
About Tom Entrikin
A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.
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