Bill Overview
Title: Technology-Enabled Care in the Home (TECH) Act
Description: This bill provides for the Center for Medicare and Medicaid Innovation to test a model for furnishing at-home telehealth, remote patient monitoring, and other technology-enabled care interventions for chronically ill individuals who are enrolled in certain Medicare Advantage plans. The model must test the effect of such technology on Medicare Advantage spending and the overall quality of care for beneficiaries. The bill also repeals provisions that prohibit the correction of earnings records for purposes of Social Security benefits after certain time limitations expire and determinations become final.
Sponsors: Sen. Scott, Tim [R-SC]
Target Audience
Population: Chronically ill individuals in Medicare-equivalent systems
Estimated Size: 18600000
- The main population impacted is chronically ill individuals enrolled in Medicare Advantage plans, as the bill focuses on developing technology-enabled care for this group.
- The global target population contingent on Medicare Advantage plans will be those in developed countries that have adopted similar healthcare systems or policies.
- In the United States, Medicare Advantage serves about 31 million people as of 2023.
- Of those, not all are chronically ill; a significant portion however, likely fits this description as chronic illnesses are more prevalent among the elderly.
Reasoning
- The policy is specifically designed to aid chronically ill individuals who are enrolled in Medicare Advantage plans by offering telehealth and technology-enabled care interventions. This particular demographic often experiences hurdles with mobility and access to medical facilities, hence may significantly benefit from home-based care.
- Considering a budget of $1 billion USD for the first year and $7.9 billion USD over 10 years, the policy aims to cover a substantial number of chronically ill individuals whose healthcare outcomes might be improved through technology.
- Given that around 18.6 million people could be part of this target group based on their enrollment in Medicare Advantage and their likely chronic illness statuses, the budget would need to be strategically allocated to those who might see the most benefit, such as people living in remote or rural areas, or those with severe mobility issues.
- The impact of such policies often varies widely based on individual circumstances, including existing health conditions, access to technological resources, and personal adaptability to telehealth methods.
- While some individuals might experience a substantial uplift in their well-being due to reduced strain from traveling to get healthcare, others might find the transition to technology-based care challenging due to lack of familiarity or comfort with technology.
- It's crucial also to consider individuals who might not observe significant changes due to pre-existing excellent healthcare access or those with conditions not suited to telehealth solutions.
Simulated Interviews
Retired teacher (Austin, Texas)
Age: 78 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- I'm a bit apprehensive about using new technologies, but the idea of not having to travel to the clinic often is appealing.
- If this makes it easier to consult with doctors, I'll feel more secure managing my health.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retired factory worker (Chicago, Illinois)
Age: 72 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- This tech stuff is a bit over my head, but anything that helps manage diabetes without frequent trips to the doctor is welcome.
- My main concern is whether this will actually make things cheaper or if it just looks good on paper.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Part-time nanny (Los Angeles, California)
Age: 65 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I already use apps to track my health stats, so more telehealth options are exactly what I've been hoping for.
- It's rewarding to see Medicare going in this direction, as tech can make my life so much easier.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
Retired farmer (Boise, Idaho)
Age: 66 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I don't know much about technology but living out in the countryside, anything that could save me trips to the hospital is worth trying.
- As long as it doesn't mean new expenses I can't afford, I'd be willing to learn.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Retired (Miami, Florida)
Age: 81 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 14/20
Statement of Opinion:
- The idea of not being rushed around for appointments is appealing, but I worry about using tech without hands-on help.
- Maybe if they provide some training on how to use these gadgets first?
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 4 | 4 |
| Year 20 | 3 | 3 |
Retired corporate lawyer (New York City, New York)
Age: 60 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 6/20
Statement of Opinion:
- Technologies are tools, not replacements. It's good to have options but not at the cost of face-to-face consultations.
- The policy sounds promising but might not be a game changer for those already having good healthcare access.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Retired nurse (Rural Arkansas)
Age: 70 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- I support anything that might reduce my physical burden of going to town for checkups, but reliability is crucial.
- Connectivity issues here could really influence how effective this would be.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Self-employed writer (Phoenix, Arizona)
Age: 63 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- The policy seems targeted at my situation, as I've been seeking more effective ways to manage my condition remotely.
- My main worry is whether the devices provided will be comprehensive enough to support my needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 4 |
Retired chef (Seattle, Washington)
Age: 59 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 13/20
Statement of Opinion:
- I already have patient portals set up but having even more advanced tech could enhance self-care.
- Urban patients like me might not feel a profound impact unless this tech offers something truly novel.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 5 |
Retired (Philadelphia, Pennsylvania)
Age: 85 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 7.0 years
Commonness: 7/20
Statement of Opinion:
- Assisted living provides most of what I need, but if more tech could bolster memory care, that'd be a blessing.
- Concerned mainly about adaptability and how staff will incorporate new technologies.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 4 | 3 |
| Year 20 | 3 | 2 |
Cost Estimates
Year 1: $1000000000 (Low: $800000000, High: $1200000000)
Year 2: $1050000000 (Low: $850000000, High: $1250000000)
Year 3: $1100000000 (Low: $900000000, High: $1300000000)
Year 5: $1200000000 (Low: $1000000000, High: $1400000000)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Effectiveness of telehealth in managing chronic diseases is critical to realizing potential cost savings.
- Adoption and engagement rates among beneficiaries will influence both costs and outcomes.
- Initial implementation costs may be higher than anticipated due to infrastructure setup and administrative requirements.
- Long-term savings potential depends on successful adoption and improvement in patient outcomes.