Elderly person getting help from care giver
June 8, 2018

One-third of older adults who receive health coverage through Medicare Advantage report difficulty with the activities of daily living, and nearly half who reported difficulty don't have help. Can the CHRONIC Care Act help?

Passed as part of the Bipartisan Budget Act of 2018, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act has given hope to those working to address the needs of people living with disabilities or chronic illness. Beginning as early as next year, it could provide coverage for health and well-being needs that are not strictly medical, such as hiring a handyman to install grab bars or receiving home delivery of prepared meals. These benefits would be available to Medicare Advantage beneficiaries, who make up more than one third of all Medicare recipients.

In a “perspective” article published in the New England Journal of Medicine, Dr. Eva DuGoff, assistant professor at the University of Maryland School of Public Health and Dr. Amber Willink, assistant scientist at the Johns Hopkins Bloomberg School of Public Health, analyze the promise and the potential pitfalls of the CHRONIC Care Act and how it will be implemented.

 “While the CHRONIC Care Act is new and exciting and could expand the range of services that are covered, we have to be wary of favorable selection and how this might affect who is enrolling in these plans,” DuGoff, who is in the Department of Health Services Administration, explained.

Older adults with chronic health conditions are at high risk for hospitalizations or emergency department visits, which are very costly, but there’s evidence that some of these adverse events could be prevented if they had access to more long term support services, like those that the CHRONIC Care Act could provide.

The authors argue that: “The promise of better outcomes and significant cost savings as a result of reduced hospitalizations and emergency department visits should give the plans opportunities to better serve high-need beneficiaries. Yet these changes may also attract the sickest beneficiaries who require the costliest care to switch from traditional Medicare to Medicare Advantage.”

As a result, “They may be less inclined to offer benefits that could make a difference to the chronically ill if they are attracting primarily the sickest beneficiaries who cost the most,” Dr. DuGoff said.

Read their complete analysis: Integrating Medical and Nonmedical Services — The Promise and Pitfalls of the CHRONIC Care Act

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Integrating Medical and Nonmedical Services — The Promise and Pitfalls of the CHRONIC Care Act

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Eva DuGoff