High-Need, High-Cost Patients

State of Play:  The administration has issued an unprecedented array of temporary regulatory waivers and new rules to help the healthcare system respond with maximum flexibility to the COVID-19 pandemic.  In particular the Centers for Medicare and Medicaid Services (CMS) provides some flexibilities to the Medicare Diabetes Prevention Program, as well as all other programs that provide services to those beneficiaries with chronic healthcare conditions.  CMS released a report on the Z codes providers use to report Medicare fee-for-service social determinants of health (SDOH).  The report notes providers used the codes to document 467,136 Medicare fee-for-service beneficiaries in 2017.  The most used codes were those for homelessness, problems related to living alone, death of a family member, and other problems related to psychosocial circumstances. According to the Centers for Disease Control and Prevention (CDC), life expectancy in the United States increased for the first time in four years in 2018.

HLC Position:  HLC supports chronic disease prevention and management, which affect the Medicare population at disproportionate levels, as essential components of healthcare delivery through better public and private sector development of evidence-based wellness practices.  As various value assessments intended to determine whether new and innovative treatments warrant coverage, HLC believes any new structure should include population health and the long-term benefits of health innovations over short-term financial costs, to ensure that these innovations do not serve as unwarranted barriers to patient access. Lessons learned from new approaches within Medicare can help lead to more effective ways of preventing chronic disease.  HLC also believes it is important to address social determinants of health and provide greater support for the transportation, nutrition, and other nonmedical needs that can protect patient health and reduce the need for repeat hospitalization.  Our initial work has illuminated the need for standardized data collection to better identify individuals in need and the social determinants most affecting patients’ health and well-being.

HLC Recent Activity:

  • On April 12, HLC submitted comments to CMS on improving health care access, quality, and outcomes for women and infants in rural communities before, during, and after pregnancy.
  • On March 30, HLC submitted examples of what HLC members are doing to address COVID-19 in the Rural Aging Advisory Council’s (RAAC) newsletter.
  • HLC postponed a follow-up roundtable with Aetna and Tivity Health on addressing SDOH due to the COVID-19 pandemic.
  • On March 4, HLC attended the Administration for Community Living’s 2020 National Summit on Health Care and Social Service Integration and provided input on the agenda on a preparation call.
  • As members of the RAAC, HLC wrote the Senate Health, Education, Labor, and Pensions (HELP) Committee and the House Education and Labor Committee expressing support for the reauthorization of the Older Americans Act.
  • On February 13, HLC wrote the Senate Special Committee on Aging in advance of its hearing on “There’s No Place Like Home: Home Health Care in Rural America.”
  • On February 3, HLC submitted comments to the Department of Health and Human Services (HHS) National Clinical Care Commission on policies, effectiveness, limitations, and gaps related to prevention and treatment of diabetes and its complications.
  • HLC continues participation in organizations that support issues affecting high-need, high-cost patients, including the Diabetes Advocacy Alliance (DAA), the Obesity Care Advocacy Network (OCAN), the Partnership to Fight Chronic Disease, and RAAC.
  • On January 8, HLC wrote the House Energy and Commerce (E&C) Committee in support of H.R. 3935, the “Protecting Patients Transportation to Care Act.”
  • On December 9, HLC staff met with Cara James, Director, Office of Minority Health at CMS, to discuss the public-private sector work on SDOH.
  • On November 25, HLC responded to the House Ways and Means Committee’s Rural and Underserved Communities Health task force request for information (RFI) on policy options to improve care delivery and health outcomes for rural and underserved communities.
  • On October 10, HLC hosted with Aetna and Tivity Health at a High-Need Playbook Implementation workgroup meeting to discuss the current state of SDOH and are beginning to implement an action plan.
  • On October 3, HLC responded to the Health Resources and Services Administration’s Rural Access to Health Care Services request for information, highlighting the barriers and difficulties rural residents face in accessing healthcare stemming from SDOH.
  • On September 17, HLC held a congressional briefing with Children’s Hospital of Philadelphia, MemorialCare, SCAN Health Plan, and Senior Helpers on how healthcare organizations are working to address SDOH.
  • On September 7, HLC submitted recommendations on addressing SDOH to the Bipartisan Policy Center’s Rural Health Task Force.
  • On August 5, HLC staff met with Senate Special Committee on Aging staff to discuss the High-Need Beneficiary Playbook.
  • On July 30, HLC published a social determinants of health (SDOH) white paper, identifying key government and private sector solutions. These solutions were identified at HLC’s joint roundtable with Aetna and Tivity Health on addressing SDOH in May.
  • On July 25, HLC wrote Senator Rob Portman (R/OH) and Senator Bob Casey (D/PA) in support of S. 1323, the “UNDERSTAND Act.”
  • On June 28, HLC honored the Eastern Band of Cherokee Indians (EBCI) with the inaugural Redefining American Healthcare Award at the Cherokee Indian Hospital in North Carolina.
  • On June 26, HLC joined a group letter with Obesity Care Advocacy Network in support of S. 595/H.R. 1530, the “Treat and Reduce Obesity Act.”
  • On June 10, HLC hosted Dawn Alley, director, Prevention and Population Health Group, Centers for Medicare and Medicaid Innovation (CMMI), for the High-Need Playbook Implementation Workgroup meeting.
  • On May 17, HLC held a joint roundtable with Aetna and Tivity Health on addressing social determinants of health (SDOH) in the private and government sector.
  • On May 7, HLC hosted Kelly Cronin, deputy administrator, Center for Integrated Programs at Administration for Community Living, for the High-Need Playbook Implementation Workgroup meeting.
  • On April 5, HLC staff met with Senate Health, Education, Labor, and Pensions Committee staff to discuss the High-Need Beneficiary Playbook.
  • HLC regional directors share the playbook with key stakeholders addressing issues related to telehealth, Stark/Anti-Kickback, and social determinants of health (SDOH). HLC staff sits on the Rural Aging Advisory Council, which is focused on SDOH for 2019.
  • On March 1, HLC responded to the 2020 MA and Part D draft call letter, applauding CMS’s efforts to address social determinants of health through special supplementary benefits for the chronically ill.
  • HLC continues to support the “Preventative Health Savings Act.”
  • On February 22, HLC held a congressional briefing on the patient-centered approach to increasing quality and efficiency of care.
  • On February 21, HLC issued a press release on the High-Need Beneficiary Playbook, providing a framework and specific actions to transform healthcare delivery to high-need patients.