Jan. 16—New legislation aims to spur the transition away from fee-for-service payments to paying providers based on their patients’ outcomes.

Based on Vermont’s Blueprint for Health program, the Better Care, Lower Cost Act will encourage providers to coordinate care for the 68 percent of Medicare enrollees with multiple chronic conditions and pay them for achieving healthy outcomes rather than for the number of services they provide. It would encourage providers to develop new models that improve patient outcomes, such as telemedicine and knowledge networks to increase access in rural areas, and case management services to increase medical compliance.

The payment reform bill is backed by a bipartisan group of Senate and House lawmakers, including Sen. Ron Wyden (D-Ore.), who is expected to take over leadership of the powerful Senate Finance Committee next year.

“The point of our bipartisan legislation is to break government’s shackles on innovation so that these providers are the norm rather than the exception,” Wyden said in a release.

Although initiatives to reward care coordination were included in the Affordable Care Act (ACA), their reach remains limited. For instance, the high-profile accountable care organization program includes only 5.3 million of Medicare’s 49 million beneficiaries, according to the U.S. Department of Health and Human Services. 

Steven M. Safyer MD, president and CEO, Montefiore Health System, said his organization supports the idea of direct payment to cover the full scope of wraparound care that patients with chronic disease need. 

“The burden of chronic disease is enormous for individuals and the nation,” Safyer said. “We can best relieve the burden with doctors and professionals at all levels working with patients to maintain their health.”

The legislation also has drawn the support of patient advocacy groups like the AARP.

“It is important to better coordinate and improve the quality of care for these individuals, with the opportunity to better control or reduce costs in the process, rather than to just ask individuals to continue to pay more for their health care,” David Certner, legislative policy director for the AARP, said in a statement.

Publication Date: Thursday, January 16, 2014