Bipartisan bill proposes new provider networks to serve chronically ill seniors

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Sen. Ron Wyden (D-OR), chairman of the Senate Finance Committee
Sen. Ron Wyden (D-OR), chairman of the Senate Finance Committee

Skilled nursing and rehabilitation providers would be able to join networks dedicated to treating chronically ill Medicare patients, under a new bipartisan bill introduced Wednesday in both houses of Congress.

“It is essential that we do a better job coordinating healthcare services for seniors suffering from chronic diseases,” said Rep. Peter Welch (D-VT), one of the bill's co-sponsors. “Every day, these seniors struggle to navigate a maze of healthcare providers, too often on their own.”

The “Better Care, Lower Cost Act” seeks to establish the Better Care Program, which would enable healthcare providers to form networks similar to accountable care organizations, but with a special focus on coordinating care for those with chronic conditions.

BCP networks would not be subject to an "attribution rule" that prevents ACOs from serving only particular patient populations, such as those with multiple chronic conditions.

The payment system also would differentiate BCPs and ACOs. Providers participating in an ACO can share the savings if they successfully treat patients below a set-cost threshold, but treatments are reimbursed on a fee-for-service basis. BCPs would receive a single, capitated payment for each enrolled beneficiary.

The bill also calls for a unique care plan for each enrollee, which is not the case for ACOs.

Providers in a BCP would not have to be able to provide for the long-term care needs of enrolled patients, according to the legislation. However, BCPs should be able to offer post-acute care, including skilled nursing and rehabilitation.

The 54-page bill also includes provisions related to where BCPs could be formed, how prescription drug plans would be involved, how telemedicine could be leveraged, and how medical schools should prepare graduates for participation.

Sen. Ron Wyden (D-OR) spearheaded development of the bill. He was joined in introducing it by Sen. Johnny Isakson (R-GA) and Reps. Welch and Erik Paulsen (R-MN).

Click here for the full text of the legislation.

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