The federal government recently extended funding for a pilot program that supports Vermont’s Blueprint for Health, a primary care management initiative.
That is welcome news for seniors at Town Meadow Senior Housing in Essex, who benefit from Blueprint’s Support and Services at Home, or SASH, program.
SASH is essentially an extension of Blueprint’s multidisciplinary community health teams, which bring social workers, nurses and therapists into a place like Town Meadow to help seniors live healthier and stay independent.
Town Meadow serves its own residents, but also acts as a hub for seniors living in their own homes who need similar support.
“What’s really great about this program is that it gives us a lot of flexibility,” said Nancy Eldridge, CEO of the nonprofit affordable senior housing company. SASH allows rehab and physical therapy programs to be tailored to seniors needs, with options like tai chi and counseling, she said.
SASH is supported by $700 per person per year payments from Blueprint, which is in turn funded through per member per month payments from commercial insurers, Medicaid and Medicare.
The federal extension of what is known as Multi-Payer Advanced Primary Care Practice ensures that Medicare will continue to make payments to Blueprint.
However, the federal government also plans to offer primary care doctors an alternative, and substantially larger, care management payment through Medicare for seniors with multiple chronic conditions starting in 2015.
If primary care doctors decide to leave Blueprint for the Medicare alternative, it will siphon money away from Blueprint and ultimately from SASH.
Blueprint makes capped payments to doctors and care management teams that allow for the flexibility in how those payments are used.
The new Medicare alternative is a fee-for-service payment, meaning when doctors bill for individual services that meet certain criteria they will be able to bill an additional care management code too.
The new federal offering makes sense for states that aren’t pursuing care management initiatives, said Blueprint Director Craig Jones, but it will only create confusion in Vermont.
He anticipates a “management nightmare” for primary care doctors who try to shift a subset of their Medicare patients, those with multiple chronic conditions, from Blueprint to the new Medicare fee-for-service option.
If Medicare’s auditors think beneficiaries attributed to one program are being supported by payments made from another, they will look at it as double-billing and seek repayment from doctors, he said.
Though there is some doubt about its future, SASH appears to be working.
The number of seniors receiving SASH services who have had a fall has dropped 40 percent in three years, according to Eldridge.
Ninety-six percent of participating seniors have a primary care doctor and the number receiving flu shots has increased from 50 percent to 80 percent during that same period, she said.
