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Where is Your Advance Directive?

April 16, 2015
3:27 pm

Today is National Healthcare Decisions Day and, with it, a discussion revolving around end of life care and decision making. The Institute of Medicine recently published a report entitled “Dying in America” and, according to its study, less than 30 percent of Americans have discussed their end of life preferences with family members or their physician. The focus on end of life is not meant to be morbid; there is importance in making people feel comfortable conversing not only about how we live but how we die. The IOM report recognizes that Americans are not well informed about end of life care choices, and that physicians often don’t tie those options into their patients’ overall care plans. Recommendations include educating patients and physicians alike in how to communicate with each other on this issue, providing them with information on palliative care, and standardizing the advance planning approach.

In addition to the need for heightened awareness of advance planning, there is also the dilemma of where to store the advance directives.  A case was recently discussed in the New York Times in which a man had filled out an advance directive that indicated he was not interested in drastic lifesaving procedures. When an emergency occurred the form was not noticed until a week of lifesaving procedures had taken place.

Electronic copies of advance directives are the obvious solution, as they can be shared efficiently and as widely as one would like.  A problem is the lack of interoperability between providers.  Just because a primary care physician has a copy does not mean that the emergency room will have access to it.  Simply having an advance directive is not enough; the healthcare system needs to find a way to ensure that providers are utilizing them once patients are in an incapacitated state.  This will not only make tough decisions easier for family members, but it could make more cost-effective use of healthcare resources when patients opt for palliative treatment .

There is great value to be had in end of life care discussions. Providers and patients alike need to be properly informed on the benefits of palliative care and the importance of an advance directive. By coordinating care and working to improve the transfer of data between health systems we can ensure that the wishes of patients and their families are respected.

The Congressional Budget Debate and Its Potential Impact on American Seniors

March 25, 2015
2:51 pm

This is the time of year in which the President, the U.S. Senate and House engage in a debate over the federal budget for the coming fiscal year.  This is not so much a discussion about dollar figures as it is about the priorities and values we embrace as a nation.

As this debate unfolds, one of those priorities that must be protected is the health of our nation’s seniors.

This week, the U.S. Senate is considering its fiscal year 2016 budget and there are rumblings that it may include amendments that target the Medicare Part D prescription drug program.  Specifically, there are some Senators and interest groups that would like to enable federal government interference in the private sector drug pricing negotiations that have, since Part D’s inception, kept beneficiary costs affordable and saved money for American taxpayers.  Bringing the federal bureaucracy into a process where it is not needed – and which the law that created the Part D program specifically forbids – could raise prescription drug costs and reduce seniors’ access to the medications they need.

To monitor this possible legislation and other issues affecting seniors’ access to prescription drugs, I refer you to the Seniors Speak Out Facebook page, which serves as an online resource hub for developing information on Medicare Part D.  On this site, individuals can also send a letter directly to their U.S. Senators to encourage that affordable Medicare drug coverage should be protected, not threatened.

The federal budget process is supposed to reaffirm the policies and programs that reflect what this nation holds dear.  Undermining Medicare prescription drug coverage would do exactly the opposite.

The Lasting Resonance of a Summit on Health Care Value

March 18, 2015
11:41 am

On March 2, the Healthcare Leadership Council, as part of its National Dialogue for Healthcare Innovation (NDHI) initiative, brought together over 70 leaders from organizations and institutions that design, implement and are affected by the U.S. healthcare system.  The purpose was to clearly define what constitutes value in healthcare and to begin crafting a pathway that will allow patients and consumers access to life-changing healthcare innovations within a structure that is affordable and financially sustainable.

The Summit on Value and Innovation was just the first step in what will be an ongoing dialogue designed to identify and address the existing barriers to health system improvement.  Summit participants have expressed their intention to continue working toward the goals and objectives they outlines on March 2.

Here are some highlights of the comments and coverage of the NDHI Summit:

“Last week I had the opportunity to sit at the table with some of the nation’s top thought leaders. We convened at the Newseum in Washington, DC, for the Healthcare Leadership Council’s National Dialogue for Healthcare Innovation; it was like a health policy nerd red carpet. Center for Medicare Director Sean Cavanaugh was there. Leapfrog Group CEO Leah Binder was there. America’s favorite bioethicist–oncologist–provocateur Zeke Emanuel was there. The chief executives of providers, payers, pharmaceutical companies, government agencies—all there. And what were they there to do? Define “value” in health care.”

–Neel Shah, M.D., Executive Director, Costs of Care in the AAMC Wing of Zock blog

***

“In order to improve value, we needed to identify some of the obstacles that could thwart progress. Regulatory and policy challenges; trust between stakeholders; insufficient time for measurement and lack of tools for patients to make healthcare decisions were among the barriers we cited.

“To surmount those obstacles, we honed in on several key initiatives: piloting a payment model that incentivizes value and shares risk among stakeholders; mapping the patient journey to better understand how we as stakeholders can work together, rather than focusing on our individual part of a patient’s healthcare experience; and developing medication adherence programs to educate patients on their disease, therapies and treatment goals.”

–Greg Irace, Senior Vice President of Global Services, Sanofi US

***

Several participants said that the Medicare Advantage system does a good job of aligning incentives to produce high-quality care and good value. Barry Arbuckle, president and chief executive officer of MemorialCare Health System, which operates hospitals and provider groups as well as a health plan in the Los Angeles area, said, “If I could push every Medicare patient into Medicare Advantage, I’d do it tomorrow.”
Medicare Advantage is “a fundamentally better system. The financials are aligned. We have incentives to do disease-management programs. Frankly I don’t have that in Medicare, because I get paid when they get sick. And if they’re sicker, I get paid more,” Arbuckle said.

It’s more challenging to address these issues for the commercially insured population, Arbuckle said. Having a long-term relationship with members is crucial to the success of creating better health-care value, he said.

–Coverage in Bloomberg BNA, March 3, 2015

A Health Provider’s Perspective on King v Burwell

March 04, 2015
2:52 pm

With the U.S. Supreme Court having heard arguments earlier today on King v Burwell, the case that will determine whether the federal government can continue to provide health insurance subsidies to consumers who purchase coverage from the federally-administered exchange, I thought it would be particularly useful to spotlight the perspective on this issue of one of the nation’s leading healthcare providers.

Anthony Tersigni is President and CEO of Ascension Health, the nation’s largest Catholic and non-profit healthcare system.  (He is also a Healthcare Leadership Council member and former chairman.)  He authored an op-ed for The Hill, a Capitol Hill newspaper, making the point that an adverse ruling by the Court would be “effectively denying millions of people and their families – those already most vulnerable – a basic human need.”

It is my hope that lawmakers will pay close attention to Mr. Tersigni’s words and be prepared to act to help these individuals and families keep their health coverage in place if the Supreme Court rules against the Obama Administration on this issue.  His op-ed follows:

How do you tell 6.5 million people that they no longer have health insurance, some of whom just received coverage for the very first time? How do you take away affordable healthcare, especially from someone on an already limited income?

That’s the real dilemma before the U.S. Supreme Court. The case of King v. Burwell challenges the legality of tax subsidies for federally operated state exchanges. I am not a lawyer, so I will leave the detailed legal arguments for others. It is safe to say, however, that the legal argument for eliminating the subsidies rests on taking four words of a thousand page law out of context — “established by the State” — and in the process violating the intent of Congress.

As head of the nation’s largest Catholic and nonprofit healthcare system, I can attest firsthand that eliminating these critical tax subsidies will have a devastating effect on the millions of Americans who now rely on the Affordable Care Act to receive much needed access to healthcare. With subsidies available on all exchanges, more people than ever are receiving the care they need and fewer are struggling to pay for it.

I see the Affordable Care Act beginning to accomplish its goal of extending affordable coverage to the uninsured as well as making coverage more secure for those who have insurance. Before the ACA, one new uninsured person was treated every 37 seconds at an Ascension hospital location. The national uninsured rate is now down to 12.9 percent, with the greatest drop among low income Americans.

While the ACA is not perfect, it is a positive step toward a national healthcare policy — not just a healthcare financing policy that we have attempted in the past. In fact, Medicare was not perfect when it was enacted — we have made a number of major changes, and today surveys have found that seniors on Medicare are overall satisfied with their plan.

The Affordable Care Act is a good thing for society. For Ascension, that is the Mission that we are called to serve — caring for all persons with special attention to those who are poor and vulnerable. Hospitals across the Ascension health system are providing for an increasing number of patients who previously might not have come to us for care because they did not have insurance coverage.

In the 37 states that elected to have the federal government manage their exchanges, nearly 70 percent of those who have private insurance coverage through the exchanges could lose it — we’re talking about millions of people. Even those remaining in the federally operated state exchanges could see their policy costs increase by 35 percent.  To take away insurance coverage and access to healthcare would be devastating, effectively denying millions of people and their families — those already most vulnerable — a basic human need.  Neither the law’s language nor its purpose requires this outcome.

At Ascension, we proudly serve our mission in the spirit of our founders and sponsors who selflessly cared for vulnerable people in need for centuries. As applied to our society, that vision of charitable care and social justice requires that everyone have sufficient health insurance coverage — because such coverage provides access to some of the essential basic goods necessary for living a fully human life.

As they reflect on their decision in this case, the court should look at the entire law — and the intent of Congress — instead of taking four words out of context. The court should reflect on the devastating impact that eliminating the subsidies would have on millions of Americans who are just beginning to enjoy access to healthcare, essentially stripping them of their dignity.  Giving everyone access to our healthcare system is in the best interest of creating a more compassionate and just American society.

Medicare Advantage and Lessons for Healthcare’s Future

February 05, 2015
3:08 pm

(The following post is co-authored by Mary Grealy, President of the Healthcare Leadership Council, and Don Crane, President and CEO of CAPG)

As healthcare policymakers continue to seek to incentivize value in Medicare, the successes of the Medicare Advantage program cannot be ignored.

The Healthcare Leadership Council and CAPG are strong supporters of Medicare Advantage, believing that beneficiaries will gravitate toward health coverage plans that provide them with high-quality healthcare at the most affordable costs.   A recent column in Forbes highlighted how the growing preponderance of evidence shows this to be the case, pointing out that the number of beneficiaries in Medicare Advantage plans has now hit 17 million and the monthly growth rate in new enrollments is almost double what it was two years ago.  As Dr. Scott Gottlieb wrote in the column, “(Medicare Advantage) plans offer a more comprehensive set of benefits than traditional Medicare, often plugging gaps in coverage or helping to offset out-of-pocket costs.  Seniors also prefer a network that plans offer, and their ease of use.”

(Of note, the Healthcare Leadership Council will be sponsoring a Capitol Hill briefing on Medicare Advantage on Friday, February 6, featuring experts from SCAN Health Plan, MemorialCare Health System and The Latino Coalition.  The briefing is at noon, ET and interested individuals can attend by contacting Amanda Uherek at auherek@hlc.org.)

The impact on the healthcare system as a whole from the growing popularity of private Medicare Advantage plans is a positive one.  A study published in Health Affairs examined the rate at which different types of Medicare beneficiaries accessed preventive care services.  Just over one in four enrolled in traditional Medicare fee-for-service had annual preventive doctor visits.  For those in private Medicare plans, however, was 44 percent.  The more we can increase adherence to preventive care, the more we can reduce costs associated with hospitalizations, emergency room visits and acute care services.

Given the evidence, it seems odd that there is still controversy surrounding Medicare Advantage.  This is the case, though.  Despite the popularity of this program with seniors, Medicare Advantage has been the subject of repeated year over year cuts.  These cuts have come from a variety of sources – legislative and regulatory – and more cuts are on the horizon.

The facts are clear.  Medicare Advantage is growing in popularity among seniors who choose private plan options over traditional fee-for-service coverage.  And, most importantly, Medicare Advantage is getting results in terms of keeping people healthier and reducing the need for more expensive healthcare interventions.  There are answers here that can help address the challenges facing our nation’s healthcare system.