in 2006 to 775 in 2008. As of November 2007, SNPs had enrolled more than 1 million Medicare beneficiaries (Harrison and Podulka, 2007). SNPs were reauthorized through the end of 2009,5 including a 1-year moratorium for new SNPs. To evaluate the effect of using SNPs, CMS contracted with the National Committee for Quality Assurance (NCQA) to develop SNP-specific measures based on those used for the Healthcare Effectiveness Data and Information Set (HEDIS). Measures specific to the care of older adults include glaucoma screening, osteoporosis management, and use of high-risk medication (NCQA, 2008). SNPs were required to report on these measures by June 30, 2008; data regarding the results of this evaluation were not available at the time this report was prepared.

MedPAC Approaches

A number of additional proposals to support new models of care have been developed. MedPAC proposed two approaches for enhancing care coordination in Medicare FFS (Stone, 2000). Under the first approach, group practices or integrated delivery systems would furnish care-coordination services to high-risk patients (e.g., a nurse care manager would share space with the physicians). These group practices would be responsible for investing in information technology and in a nurse-manager infrastructure in order to better manage care. Under the second approach, solo or small group practices would refer high-risk patients to an affiliated care-management organization that would employ the care-manager nurses and have information systems to assess patient severity levels and target interventions. Medicare would pay the care-coordination entity (either the group practice or the care-management organization) for services, and that payment would be tied to cost savings and quality goals. Payment would be either shared savings or an at-risk care managed fee. Medicare would also provide an incentive payment to physicians to encourage them to collaborate with the care managers.

Addition of Medicare Benefits

Another way to support new models of care would be for Congress to create additional Medicare benefits. For example, one proposal calls for the creation of a modified home visit benefit for beneficiaries in need of extended home-nursing and personal-care services (Berenson and Horvath, 2003). The new, lower-level home health benefit would not be as intensive as the current home health benefit, but it could allow instead for physicians


Medicare, Medicaid, and SCHIP Extension Act of 2007. Public Law 110-173. 110th Congress. (2007).

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