Innovative Health Care Program Could Save Lives and Money

Hrant Jamgochian, DPC

March 6, 2017

Ever since November 8, 2016, the future of taxpayer-funded healthcare has been in the spotlight.  Taxpayers want the government to be compassionate and thrifty.  One issue where these two ideals intersect is end-stage renal disease (ESRD).  Like most chronic disease patients, people living with ESRD often find out that managing their care can be as difficult as managing their condition. The need for multiple doctors, specialists, prescriptions and facilities can often leave patients feeling confused about how to get the most effective care – which they often don’t. What’s more, poorly managed care compounds inefficiencies and increases costs across the health care system.

The good news is that Medicare is experimenting with ways to produce better care for ESRD patients at lower costs. The largest such demonstration project created ESRD Seamless Care Organizations (ESCOs), which currently exist in 37 locations across the country. Under this model, care managers assist patients with tasks such as making doctor appointments, getting answers from pharmacists and cutting through red tape with dentists or state assistance programs.

ESCOs offer coordinated care that benefits patients in numerous ways, including transitioning patients from hospital to home and avoiding readmissions, reconciling multiple medications, managing comorbidities, involving clinicians at a patient’s dialysis facility in the care planning, and closely engaging patients in decisions about their own care. At the same time, ESCOs have come under criticism for stringent risk sharing requirements and other administrative burdens that have discouraged some providers from participating, as not every doctor wants to put their practice at risk.

The Dialysis PATIENTS (Patient Access To Integrated care, Empowerment, Nephrologists, and Treatment) Act was introduced in both chambers of Congress last year.  If passed, this legislation would increase patient choice and access to care coordination called.  This legislation creates another demonstration that would permit dialysis organizations to accept capitated payments to cover all of an ESRD patient’s Medicare expenditures in return for coordinating care for their renal disease and other health conditions. The program, which would be voluntary for patients, would provide access to an expanded clinical team that would “quarterback” their care. Best of all, patients would retain their freedom of choice to use any Medicare provider.

The Dialysis PATIENTS Act was introduced in the House by Reps. Young (R-Ind.), Blumenauer (D-Ore.), McMorris Rodgers (R-Wash.) and Cardenas (D-Ca;if.), and in the Senate by Senators Heller (R-Nev.) and Nelson (D-Fla.).  Coordinated care among health providers can lead to better outcomes for patients and lower health care spending. The Dialysis PATIENTS Act would permit more Medicare beneficiaries with ESRD to benefit from care coordination, while retaining their freedom of choice to see any provider and a right to opt out if they do not want to participate.

It is time for Congress to allow innovative health care ideas to flourish.  Patients and taxpayers deserve the best.

Hrant Jamgochian is the Chief Executive Officer of Dialysis Patient Citizens