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Dr. Navathe Testifies Before U.S. Senate Committee on Finance About Improving Chronic Care

Amol navathe

CHIBE Associate Director Amol Navathe, MD, PhD, spoke about potential avenues to improve chronic care through Medicare physician payment in his expert testimony before the U.S. Senate Committee on Finance on April 11, 2024.

He shared three key points:

  1. “Chronic diseases may be the single most important challenge affecting Medicare beneficiaries and thus the Medicare program.
  2. Dramatic fragmentation in care makes addressing chronic disease a burden.
  3. The American care system prioritizes producing more health care, rather than producing more health.”

Dr. Navathe noted that not only do patients with multiple chronic conditions face adverse financial outcomes and in some cases are unable to work due to symptoms, but also their care costs the American health care system more than $1 trillion annually.

The US health care system is fragmented, with 35% of Medicare beneficiaries seeing 5 or more physicians in 2019. This care can be hard for patients to manage and can also lead to care coordination efforts slipping through the cracks, Dr. Navathe said.

“While having multiple physicians can tailor treatment to the needs of a patient’s condition, it can also increase the likelihood of medical errors, redundant visits, preventable hospitalizations, and substandard care due to incomplete communication and differing treatment strategies,” he said.

He also noted that the fee-for-service reimbursement system is problematic because it incentivizes clinicians to increase the number of visits or procedures, thereby not directly reimbursing the services associated with care coordination.

“With good intentions, Center for Medicare and Medicaid Services (CMS) has tried to fill this gap by adding more billing codes in an attempt to more comprehensively tie payment to effort,” Dr. Navathe said. “Unfortunately, it is a fraught effort to reduce the important work of physicians and other health care providers to a list of codes. This has resulted in an administratively burdensome system of ‘ticky tack’ codes that get underused because the cost of submitting the bill exceeds the payment doctors receive.”

How to Address These Challenges

Dr. Navathe named a few ways to help improve chronic disease care:

  • Change the way health care is delivered by investing in telehealth and expanding the role of staff practices like care coordinators and case manages and hiring community health workers.
  • Increase investments in primary care and position primary care providers (PCPs) to be the “quarterback” of the patient’s care.
    • Consider giving PCPs consistent per-beneficiary, per-month payments in addition to certain fee-for-service payments to compensate for the 25% or so PCP activities that aren’t accounted for in the Medicare Physician Fee Schedule (such as care coordination and communication with other providers).
    • With Congressional help, implement hybrid primary care payments.
      • Dr. Navathe touted Blue Cross Blue Shield of Hawaii or Hawaii Medical Services Association’s test of hybrid payments for primary care (its Population-based Payments for Primary Care model), which led to improvements in quality, greater use of telehealth, fewer low-value imaging tests, and more cost-effective prevention care.
  • Another option: consider expanding alternative payment models, “which increase accountability for cost and quality outcomes onto providers, shifting provider focus to value.”
  • Help CMS manage the increasingly complicated fee-for-service program more effectively.
    • “Ultimately, CMS needs the ability to catalyze a new care model and that will require adapting the fee schedule to accommodate approaches like a per-beneficiary, per-month payment,” he said, noting that multi-disciplinary experts will be needed to provide input to CMS.

Many of these potential paths to addressing these challenges are interrelated and could benefit from concurrent and/or collaborated implementation. “Acting now is paramount to improve the landscape of chronic condition care management and payment,” Dr. Navathe concluded.

Watch Dr. Navathe’s appearance or download his testimony here.

In addition to serving as a CHIBE Associate Director, Dr. Navathe is also director of the Parity Center, whose mission is to reform health care payment to promote equitable health care delivery and outcomes. He is also Professor of Health Policy and Medicine at the Perelman School of Medicine, a Staff Physician and Core Investigator with CHERP at the Philadelphia VA Medical Center, and Vice Chair and Commissioner, Medicare Payment Advisory Commission (MedPAC).