The Centers for Medicare & Medicaid Services’ (CMS') controversial efforts to curb the health care costs of the nation’s poorest seniors may not be the last word on reform, a top CMS official told a Senate hearing on Wednesday.
“There’s going to be a lot of give and take as we assess the proposals,” said Melanie Bella, director of CMS’ Medicare-Medicaid Coordination office, in testimony before the Senate Special Committee on Aging.
“We have not approved any demonstrations yet. There certainly is a lot of interest in the proposals that have all been publicly posted. The goal is not to have one … model. The goal is to have seamless, accountable care.”
Bella’s agency has come under public scrutiny as it looks for ways to coordinate the care for those patients who are eligible for both Medicare and Medicaid. Last week, Sen. Jay Rockefeller (D-W.V.) urged CMS to go back to the drawing board on its Financial Aligment Iniatitive, saying that its care model was overly focused on trimming costs and not on providing quality care.
Among Rockefeller’s biggest concern was so-called passive enrollment, in which beneficiaries dually eligible for both Medicare and Medicaid are simply funneled into health care plans and the capitated care model.
In her testimony Wednesday, Bella repeatedly told the Senate that her office merely looked at such initiatives as policy “tests” or “guides,” not as final policies. She said her agency was “committed to openness and transparency” and would continue to work with states and providers to get the best possible care at the best possible costs for the dual eligibles.
“We are learning and adapting,” she said in an exchange with Committee Ranking Member Bob Corker (R-Tenn.).
Nonetheless, reforms are necessary--and coming, Bella said.
“Simply put, the status quo is not working,” she said. “These are real people, stuck in broken systems. Our job is not simply about numbers and charts and savings, it’s about real people.”
Among the things that CMS has learned is that the capitated model is providing the most “stability” and clarity, Bella said.
Health care costs for dual eligibles exceed $300 billion every year, according to CMS statistics. The dual eligibles make up just 15 percent of Medicaid enrollments, but account for 39 percent of its costs. They account for 18 percent of Medicare enrollments but eat up 31 percent of Medicare costs, CMS said.
Neither Corker nor committee Chair Sen. Herb Kohl (D-Wis.) took up Rockefeller’s concerns directly, although Kohl said that “concerns had been raised.” Both men said that CMS has to walk a careful line in providing the best possible care for the most reasonable price.
“There is much more that we can do so that dual eligibles get quality care at a reasonable cost,” Kohl said.
The American Health Care Association (AHCA) said it remained uneasy Wednesday despite CMS’ apparent climb-down from its initiatives. In a statement from Gov. Mark Parkinson, AHCA president and chief executive officer, said that “any effort to save money in this population must be done very, very carefully.”
“Coordination of benefits and other efforts should focus on better health for these seniors, with an outcome of savings to the taxpayer,” Parkinson said. “CMS’ capitated, risk-based approach for dual eligibles is extremely concerning because the main focus appears to be reducing financial resources to this population and not providing better care.”