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With Medicare’s annual fall enrollment in full swing, people with Medicare are likely hearing a lot about the program’s two alternatives: Medicare Advantage—the program’s private plan option—and Original Medicare—the program’s coverage option managed by the federal government. Contrary to what the term Original in Original Medicare may imply, this part of Medicare has not remained static when it comes to ensuring that people receive care that is organized around their unique needs, preferences, values, and goals—an approach often called person- and family-centered care (or person-centered care for short).
Below we look at some notable innovations in Original Medicare that put person and family first.
Putting Each Person at the Center of Care
In addition to tailoring health care services, the goal of person- and family-centered care is to ensure the person and family caregiver are included in discussions and decisions to the extent they choose. The idea is that approaching health care as a partnership among clinicians, the person receiving care, and family caregiver leads to better health outcomes and improved care experiences. Prioritizing good communication and coordination among the various medical professionals involved in the person’s care is a key element.
For people with Medicare, person-centered care could help ensure a smooth recovery after a hospital stay with transition planning that takes into account the person’s specific needs and whether family members or friends are available and able to assist at home. Or, it could help avoid unnecessary treatments or medical tests when there is active communication and coordination among a person’s various health care providers—something that is especially important for people with multiple chronic conditions. Other examples of person-centered care include finding ways to safely treat people at home where they feel most comfortable, checking in with patients (and their family caregivers) soon after they leave the hospital, and ensuring the person and family caregiver can get answers to questions as they arise.
In Original Medicare, Innovations that Keep Sight of The Person Behind the Condition
To advance person-centered care in Original Medicare, policymakers have developed a variety of new ways to provide and pay for care. Below are three such examples. As we highlight in a recent report, in some cases, innovations are happening on a limited basis, through pilot programs. In other cases, new person-centered approaches are now a permanent feature of Original Medicare.
Independence at Home
Independence at Home is a Medicare pilot program that serves individuals with high health care needs who, because of functional limitations, have difficulty leaving home. People enrolled in the program get their primary care in their home rather than in an office. The goal is to ensure that patients receive high quality care that incorporates their individual needs and preferences and helps prevent a need for hospital care.
People enrolled in Independence at Home can get home visits from their primary care doctor as well as other health care professionals, such as nurse practitioners, registered nurses, physical therapists, and clinical social workers. An additional benefit is round-the-clock access to their health care team (for example, by phone). People in the program have in-home access to some types of technology used to diagnose a condition that are usually only available in a medical office (such as X-ray imaging). The primary care clinician serves as a central coordinator, making sure all the professionals involved in a person’s care are working together.
Currently, the pilot program allows up to 20,000 eligible individuals with Original Medicare nationwide to enroll in Independence at Home. There are nine sites with participating providers across the country.
Comprehensive Primary Care
In the Comprehensive Primary Care Plus initiative, Medicare is partnering with other payers (private insurance plans and Medicaid) to give primary care practices financial support and incentives to transform how they provide care. The goal is for practices to invest in staff and technology needed to ensure patients receive well-coordinated person-centered care. For example, practices could use the enhanced financial support to offer round-the-clock phone access to a medical professional in their office, or to hire staff to help patients arrange transportation or physical therapy. Other examples of benefits that patients may get include having a documented care plan that includes the patient’s goals and preferences, having their family caregiver included in health care decisions, getting help identifying and communicating with specialists, and receiving a follow-up call after an emergency room visit.
Like Independence at Home, Comprehensive Primary Care Plus is a pilot program. It is currently underway in about 2,600 participating practices across the country, serving about 2 million people with Medicare.
Transitional and Chronic Care Management Services
Beginning in 2013, Original Medicare started expanding its coverage of doctors’ and other clinicians’ services to include a variety of activities intended to ensure care is timely and well-coordinated—services known as care management activities. By covering these services, Medicare seeks to encourage medical practices to provide more of these care management services, which benefit patients and their family caregivers. In contrast to the other innovations described here, these are not pilot programs; all eligible clinicians nationwide may provide and bill Medicare for these care management services when provided to qualified Original Medicare patients.
One important care management service is Transitional Care Management, which supports individuals who move from a hospital or skilled nursing facility to home or to another setting. Individuals receiving Transitional Care Management can expect their doctor to contact them within a few days after they leave the hospital or skilled nursing facility, meet with them (and their family caregiver) in person within one or two weeks, and coordinate all their care for a month. This service can help ensure a smooth transition and prevent avoidable trips to a hospital.
Also notable is Chronic Care Management, which, like Transitional Care Management, is a relatively new service. Chronic Care Management is for people with Original Medicare who meet certain criteria, such as having multiple serious chronic conditions, and who agree to participate. With this service, patients benefit from various health care management activities that doctors conduct outside of office visits, such as developing a comprehensive plan of care for the patient and communicating with other doctors. Patients can also count on meeting with the same doctor or nurse practitioner for routine appointments. And for urgent needs, patients and family caregivers can reach a doctor or other professional in the practice at any time.
Looking Ahead: A Continued Focus on Person- and Family-Centered Care in Original Medicare
As these examples illustrate, Original Medicare is evolving when it comes to delivering person-centered care. Through these and other innovative models, the program is continuing to design and test ways to improve the quality of care and the experiences of patients and families. As Original Medicare keeps innovating, continued attention to strengthening person- and family-centered care will be critical to meeting the needs of the millions of individuals and families who rely on the program.