Introduction
The CHRONIC Care Act, enacted as part of the Bipartisan Budget Act of 2018, has opened new avenues for Medicare Advantage (MA) plans to address social determinants of health (SDOH). This legislation allows for the provision of Special Supplemental Benefits for the Chronically Ill (SSBCI), offering a unique opportunity for practitioners to enhance care for enrollees with chronic conditions. This blog explores how practitioners can leverage these opportunities to improve patient outcomes and encourages further research into the practical applications of the Act.
Understanding the CHRONIC Care Act
The CHRONIC Care Act represents a significant shift in how MA plans can address SDOH. Traditionally, Medicare did not cover supplemental benefits that did not directly relate to medical costs. However, with the introduction of SSBCI, MA plans can now provide services that, while not primarily health-related, have a reasonable expectation of improving or maintaining the health or overall function of chronically ill enrollees.
Opportunities for Practitioners
Practitioners can play a crucial role in implementing the provisions of the CHRONIC Care Act by:
- Identifying Eligible Beneficiaries: Practitioners should familiarize themselves with the eligibility criteria for SSBCI, which includes having one or more comorbid and medically complex chronic conditions, a high risk of hospitalization, and requiring intensive care coordination.
- Innovative Service Delivery: The Act allows for a broad range of services, such as home-delivered meals, transportation for non-medical needs, and pest control. Practitioners can collaborate with community-based organizations to deliver these services, enhancing patient care beyond traditional medical interventions.
- Advocacy and Education: Educating patients about their eligibility for SSBCI and advocating for necessary services can empower patients and improve their quality of life.
Challenges and Considerations
While the CHRONIC Care Act provides exciting opportunities, it also presents challenges:
- Funding Limitations: The Act does not provide additional funding, requiring MA plans to be innovative in resource allocation and service delivery.
- Defining Eligibility: Determining which patients qualify for SSBCI can be complex, and practitioners must navigate these criteria carefully.
- Measuring Impact: Evaluating the effectiveness of SSBCI in improving health outcomes and reducing costs is essential for sustaining these programs.
Encouraging Further Research
Practitioners are encouraged to engage in further research to explore the full potential of the CHRONIC Care Act. Areas for exploration include:
- Longitudinal studies to assess the impact of SSBCI on health outcomes and cost savings.
- Case studies of successful implementations of SSBCI to identify best practices.
- Research into the integration of community-based services with traditional healthcare delivery.
Conclusion
The CHRONIC Care Act presents a transformative opportunity for practitioners to address SDOH and improve care for chronically ill patients. By understanding the Act's provisions and actively engaging in innovative service delivery, practitioners can significantly enhance patient outcomes. To delve deeper into the research underpinning these opportunities, please refer to the original research paper: Perspectives on Opportunities and Challenges for Medicare Advantage Plans to Address Social Determinants of Health via the CHRONIC Care Act.
