New Interventions and Preventive Care Could Lower Costs and Reduce Hospitalization for Medicare Patients

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The Bipartisan Policy Center recently found that an estimated 3.65 million Medicare beneficiaries might need more preventive care than they’re currently receiving. These Medicare patients fit into one or more of the following categories:

• Patients who aren’t dually eligible for Medicaid benefits
• Those who reside in a community setting
• Patients who have three or more chronic conditions, or who have cognitive or functional impairment

All of these factors can contribute to more hospitalizations and higher Medicare costs per patient. The BPC found that each Medicare patient who falls into one of the categories above can incur an average of $30,000 in annual healthcare costs. That’s more than twice the national average Medicare fee-for-service spending per patient.

Better Preventative Care Could Lower Costs

In light of these findings, health policy experts are looking for ways to prevent hospital stays for at-risk patients. One of their suggestions is to spend more time on preventive care. Their hope is that doing so would lower Medicare costs and result in better quality care for patients who are chronically ill.

In-home meal services offer patients better nutrition, which reduces the risk of hospitalization
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In a report published in April 2017, the BPC made a number of recommendations that might help accomplish this goal. For example, it suggests that Medicare should pay for transportation to medical appointments, in-home meal delivery and better case management. The theory is that providing better nutrition can help patients maintain a healthier baseline than if they have to shop for and cook meals on their own. Similarly, providing patients with non-emergency transportation allows them better access to preventive care. Non-emergency appointments also give doctors a chance to catch complications before they require hospitalization. In addition, individualized case management would help ensure that healthcare providers communicate with one another to find the best plan of care.

CMS Measures Fall Short

The BPC report also suggests that the Centers for Medicare & Medicaid Services reconsider its current frailty and functional impairment surveys. The BPC claims that many patients currently fall out of the high-risk, high-cost category because surveys can’t accurately measure and predict their level of impairment. Better surveys and scores will allow Medicare to give patients the benefits that they need, according to the report.

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As part of these new recommendations, the BPC also wants CMS to expand its star-ratings program for non-Medicare covered services. Their goal is to provide patients with easier access to high-level care that would lower costs by improving patient’s health.

While some of these recommendations, such as better transportation and in-home meals, might cost more up-front, the BPC believes that they could save Medicare millions in the long run by reducing the annual $30,000 cost per patient for this high-risk group.  Its recommendations would also give patients access to more integrated care and reduce the need for hospitalization.

CMS has not committed to these recommendations as yet. But it may implement some of them in the future if funding allows.