Policy Changes to Improve Care for Older Adults with Chronic Illness

On May 2 and 3, the School of Nursing sponsored a multidisciplinary “Think Tank” devoted to improving care for older adults with chronic illness. Led by Mary Naylor and Nancy Hodgson, it drew more than 40 external thought leaders, who joined Penn experts from across the University. You’ll be hearing much more in the coming weeks about the Think Tank’s recommendations, but from a policy perspective, it could not have come at a better time.

As I reflect about what I heard during the meeting, I was struck by the quiet but growing policy coalescence around this issue, especially around reducing barriers to the kinds of services older adults clearly want and need. It may not yet be a movement, but it may represent a moment for aligning payment and delivery models to meet the needs of the growing population of older adults and their family caregivers. Here I highlight a few recent policy changes:

• At least 36 states have passed various versions of the Caregiver Advise, Record, Enable (CARE) Act, originally proposed by AARP. It has garnered bipartisan support for a practical approach that requires hospitals to:
  • Record the name of the family caregiver on the medical record.
  • Inform the family caregiver when the patient is to be discharged.
  • Provide the family caregiver with education and live instruction of the medical tasks he or she will need to perform for the patient at home.
     
• The needs of family caregivers has risen to the level of federal action with the recent passage of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act. It directs the Secretary of Health and Human Services, in conjunction with a Family Caregivers Advisory Council,  to develop a national strategy within 18 months that includes:
  • Promoting greater adoption of person- and family-centered care in all health and long-term services and supports settings, with the person receiving services and supports and the family caregiver (as appropriate) at the center of care teams.
  • Assessment and service planning (including care transitions and coordination) involving family caregivers and care recipients.
  • Information, education and training supports, referral, and care coordination, including hospice care, palliative care, and advance planning services.
  • Respite options.
  • Financial security and workplace issues.
  • Delivering services based on the performance, mission, and purpose of a program while eliminating redundancies.
     
• The Centers for Medicare and Medicaid Services issued a new rule for 2019 allowing Medicare Advantage (MA) plans more flexibility in offering supplemental benefits. This policy change will expand the definition of “health-related benefits” to care and devices that prevent or treat illnesses, compensate for physical impairments, and reduce avoidable emergency care.  Plans will be able to offer supportive services such as transportation to appointments, better food choices, simple home modifications, and aides for personal care needs.
   
• The Bipartisan Budget Act of 2018 included the well-acronymed CHRONIC Care Act (Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care), which will go into effect in 2020. The CHRONIC Care Act, when implemented, will give even greater flexibility to MA plans to provide support services that enable beneficiaries with chronic conditions to remain at home, increase options for accountable care organizations, and provide Medicare coverage for telehealth services for chronic conditions. Programmatically, it extends and expands the Independence at Home Demonstration, and makes permanent the MA Special Needs program, in which plans target beneficiaries with chronic conditions or those dually eligible for Medicare and Medicaid.

These policies reflect the first steps in changing a system of care that all too often provides older adults with care they do not want, while not providing them with the care they do want. The Think Tank is poised to make the most of this opportunity. Stay tuned.