The Centers for Medicare & Medicaid Services is testing the use of remote patient monitoring in new markets such as long-term care and affordable housing to illustrate the cost saving associated with telehealth services and the improved patient outcomes due to continuous care.

April 23, 2018 by Lois A Bowers

Chronic care management via telehealth and remote monitoring, service coordination in affordable housing, and long-term care financing are some of the new directions that the Centers for Medicare & Medicaid Services should explore through its Center for Medicare and Medicaid Innovation, according to feedback the agency received from providers and groups representing them.

Monday, CMS posted a 4,643-page PDF of the more than 1,000 comments the agency received after sending out a request for information in September.

At the time, CMS said it was seeking comments “on a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes.” Input was due Nov. 20.

“The responses from this RFI will help inform and drive our initiatives to transform the healthcare delivery system with the goal of improving quality of care while reducing unnecessary cost,” CMS Administrator Seema Verma wrote in an announcement accompanying Monday’s release.

Telehealth and remote monitoring

A pilot project testing chronic care management using telehealth and remote monitoring was one of the ideas that LeadingAge said it “strongly recommends.”

The proposed demonstration would include people aged 60 or more years who have at least two of five specific chronic conditions (diabetes, heart failure, hypertension, chronic obstructive pulmonary disease and asthma) and are living in their own homes or in independent living, senior housing, affordable housing or assisted living communities, or in independent living or assisted living portions of continuing care retirement communities, LeadingAge President and CEO Katie Smith Sloan wrote in her 22-page letter.

The payment system for the test could match that of the Independence at Home demonstration, she said.

Participating settings, Sloan added, would receive annual incentive payments. “Payment amounts would be based on a percentage of the Medicare savings (Parts A, B and D) achieved as a result of telehealth services used to help older adults manage chronic conditions, improve health outcomes, and reduce hospitalizations, hospital readmissions, and transitions to higher levels of care (independent living to AL or AL to skilled nursing),” she wrote.

Service coordination

Episcopal SeniorLife Communities Vice President John Broderick wrote that the company would like to see a targeted demonstration project that looks at how Medicare Advantage plan benefits could be expanded to cover wellness and service coordination for older adults and younger, disabled residents of affordable housing.

“Several options could be explored, including coverage for individuals enrolled in Advantage plans or a housing-based benefit that would be targeted to the property as a whole through a multi-payer approach,” he wrote in a four-page letter.

Long-term care financing

American Health Care Association / National Center for Assisted Living Senior Vice President of Reimbursement Policy Michael W. Cheek said that CMMI should explore private long-term care financing options.

“Research by health economists has estimated the value of family caregiving at approximately $370 billion per year,” Cheek wrote in a three-page letter. “As this capacity for informal, unpaid family caregiving declines, affordable innovative approaches to Medicare and Medicaid financing are needed, coupled with affordable private financing solutions.”

Other organizations specifically mentioning assisted living in their comments include:

  • American Geriatrics Society
  • Bayada Home Health Care
  • Blue Cross Blue Shield Association
  • Elevating Home
  • Florida PACE Centers
  • Health Care Leaders for Accountable Innovation in Medicare and Medicaid (includes AHCA/NCAL)
  • LeadingAge California
  • LeadingAge Oregon
  • LeadingAge Washington
  • National Community Pharmacy Association
  • National Disability Rights Network
  • Rockport Health Services
  • Massachusetts Executive Office of Health and Human Services


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