Medicare Looking at Telehealth to Revolutionize Chronic Care
Telehealth has long needed the silver bullet of overwhelming and broadly disseminated proof that it lowers costs while improving care to launch it firmly and irretrievably into mainstream health care. The opportunity to forge that silver bullet may at last be at hand with the passage of the Chronic Care Improvement under The Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
The Medicare Modernization Act
(MMA) establishes two new programs: the Voluntary Chronic
Care Improvement Program (VCCIP) and the Care Management Performance Program (CMPP).
These two programs are designed to study which types of interventions will
improve the health of individuals who live with chronic illnesses. VCCIP and CMP
are indicative of the increasing emphasis on cost-savings that Medicare is
placing on chronic care management. Both programs will test new performance
based contracting models.
VCCIP requires that participants be identified prospectively and that organizations be held accountable for health and cost outcomes. CMPP is a pilot program that will explore the provision of care management services in a physician delivery model at the point of care. Physicians will receive a per beneficiary payment that will vary based on different levels of performance, but the CMPP demonstration must be budget neutral.
The two programs provide a unique opportunity to prove the benefits of telehealth technologies to patients living with a chronic disease. Telehealth can be invaluable in helping them to monitor their health more effectively and in communicating more regularly and meaningfully with their health care providers.
Initially, VCCIP will include as eligible beneficiaries patients with congestive heart failure (CHF), diabetes, and chronic obstructive pulmonary disease (COPD). This program specifies the use of technology to help health care providers manage clinical information about the beneficiary. The program also calls for patient self-care guidance, an outcome that many telehealth applications already deliver.
The CMPP limits eligible beneficiaries to those enrolled in the traditional fee-for-service Medicare program who have one or more chronic care conditions to be specified by CMS. It is likely that those conditions will be the same as for the VCCIP, although cognitive impairment may also be included. The demonstration aims to promote continuity of care, to help stabilize medical conditions, to prevent or minimize acute exacerbations of chronic conditions, and to reduce adverse health outcomes, such as adverse drug interactions. Obviously, there are a wide variety of telehealth applications that can be used to meet all of these aims.
Vince Kuraitis, a Principal with Better Health Technologies in Idaho, has been following this legislation very closely. “Medicare’s chief objective in launching these two programs is to find a way reduce expenditures by limiting visits to the emergency room.” Kuraitis says that it’s not clear yet if that objective can best be met by a chronic care specific service or technology model, but finds it encouraging that Medicare is initially focusing on such telehealth-friendly diseases such as CHF, “Every study I’ve seen shows a dramatic reduction in hospitalizations and costs of treating CHF patients using telehealth—Medicare is only looking to break even.”
Whichever model proves most successful—service based or technology based—Medicare plans to roll it out nation wide in three years via newly created Chronic Care Improvement Organizations (CCIFs). The current health care system was designed to serve the needs of acute care recipients; CCIFs would be structured to provide more beneficial, and cost-effective, care for people with chronic conditions. CCIFs could be public or private and would receive reimbursement through contracts with CMS.
With the creation of these two programs, CMS is opening a new and potentially very exciting door for telehealth technologies. If telehealth can prove within them, as it has elsewhere, a high quality of chronic health care delivery at a lower cost, there is every reason to believe that CMS will expand payment for its use.
