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A Wise Withdrawal on Altering Medicare Part D

May 21, 2015
11:50 am

This morning, the House Energy and Commerce Committee voted unanimously – a rare event in these fractious political times – to send its 21st Century Cures legislation to the full House.  Progress for this measure, which will accelerate the development and delivery of new treatments and therapies while also making advances in healthcare data access and interoperability, is good news for patients and the healthcare system.

An interesting and positive development in the Energy and Commerce markup actually concerns something that didn’t happen.

One of the amendments scheduled for consideration this morning would have fundamentally changed the Medicare Part D prescription drug program by empowering the Secretary of Health and Human Services to negotiate drug prices, a responsibility now being handled by private sector health plans and pharmacy benefit management firms.

This is a status quo that isn’t begging to be repaired.  Just the opposite, in fact.  These private sector pricing negotiations have yielded a Part D program that has maintained beneficiary monthly premiums at a stable, affordable level for the past five years.  All the rhetoric in the world doesn’t change the fundamental truth that millions of seniors and beneficiaries with disabilities have affordable access to medication because of the way the Part D program is structured.

The drug pricing amendment was withdrawn before coming to a vote.  Medicare Part D stays on a path that has consistently won approval ratings of greater than 80 percent among Americans 65 and older.

Some efforts withdraw, as the saying goes, so they can live to fight another day.

Ill-conceived ideas like this one, though, should just call it a day and stay permanently out of the way of Medicare beneficiaries and the medicines they need.

The Exciting Movement Toward “Person-Centered Care”

May 20, 2015
11:46 am

American healthcare is evolving in ways that are both beneficial and necessary.  With an imperative to move toward a healthcare system that offers both high quality and cost-efficiency, the answer lies in finding better ways to keep people healthy.

In an interview with Hospital and Health Networks magazine, Ascension CEO Tony Tersigni (Ascension is the nation’s largest nonprofit healthcare system and a member of the Healthcare Leadership Council) explains how his organization is transitioning from “patient-centered care” to “person-centered care.”

This is one of the most enlightening quotes from the interview – “And so we see ourselves moving from physician-centered to person-centered, from transactional and episodic care to managed care by a team over time, from the idea of sick care to well-being.  We’re moving from care that’s inaccessible and tied to bricks and mortar to care that’s going to be convenient and available 24/7/365.”

Here is the full text of the Tersigni interview.

What is this idea of person-centered care at Ascension?

TERSIGNI: We view person-centered care as our sacred promise to support individuals’ lifelong health and well-being through holistic care. It’s something that goes back to our roots. We have a 200-year legacy of caring for the whole person — body, mind and spirit. We recognize that each person represents a unique individual biologically, psychologically and sociologically. We believe, as care develops in the future, it’s going to become much more personalized than it has been in the past. Bottom line, the emphasis on person-centered care is our way of demonstrating the commitment that our founders have had for the last 200 years.

Why is this driving the conversation at your organization?

TERSIGNI: It is our strategic direction. I might say we’ve been on this path since 2002. At that time, we created our “call to action.” It is pretty basic and simple: We are going to promise the communities that we serve health care that works, health care that’s safe and health care that leaves no one behind. Then we figured that, in order for us to do it, we needed to have four different foundational blocks. One is hired people — the people who serve those we’re privileged to serve. The second is developing trusted partnerships along the continuum. Empower knowledge, which is much more relevant today than it was in 2002. And then having this vital presence everywhere around the community.

That’s basically been the foundation of what Ascension has been. As we look at other industries, individuals have choices and options in every aspect of their daily lives, and we know that access to more and timely information really increases their options. That’s really what we’re trying to bring to Ascension and health care, and that’s how we’ve refined that focus over time.

Is “patient” not encompassing enough?

TERSIGNI: Actually, you hit the nail right on the head. We chose person-centered care because, again, it’s really focused on the person and, in many cases, they’re not patients, especially if we speak about health education and wellness. We typically don’t think of them as patients, but really as consumers. While other systems are caring for patients, we make a conscious effort to talk about providing person-centered care that’s focused on persons not on patients.

Is that difficult in such a provider-centered industry?

TERSIGNI: We’re challenging ourselves to move into health care transformation, and we believe that the first phase is seeing person-centered care. What I mean by that is we’re seeing health services being redesigned around the person, helping individuals to become participants in managing their own lives. We’re seeing care teams becoming more multidisplinary and we envision they’ll ultimately include professionals like nutritionists, social workers, coaches and partners for health. We also see that the economic model will become population based and will reward value. We’re seeing that now. And so we see ourselves moving from physician-centered to person-centered, from transactional and episodic care to managed care by a team over time, from the idea of sick care to well-being. We’re moving from care that’s inaccessible and tied to bricks and mortar to care that’s going to be convenient and available 24/7/365. There’s a lot of transformation that we believe has come and is coming to our health care industry. We want to be on that bandwagon as we move forward, because we need to move toward evidence-based standards and away from what we’ve seen in our industry is a lot of unwarranted variation. It’s a monumental transformation.

How will being person-centered help in the shift to value?

TERSIGNI: We believe we need to bring health care and health services closer to the home. We need to bring information to the persons we serve on mobile devices they use in their daily lives. Last year, if you look at [Ascension’s] total $21 billion in revenue, 51 percent of that came from non-acute care services. While people see us as a large hospital system, which we are, we’re a lot more than that. We’ve recognized that the health care landscape is changing and there are opportunities for us. So what we’ve been doing along the way is really identifying the continuum of care, the partners that we need across the continuum, and looking at the longitudinal care that we’re going to provide under population health management.

Why is clinical integration key to person-centered care?

TERSIGNI: We believe that, through clinically integrated systems of care, we can enable quality improvements and increase cost-effectiveness. That’s basically what clinically integrated systems of care are. It says that we are going to use the resources within the community to raise the quality of care of the community, and, in many cases, it’s going to be partnering with others. That’s why, when I first stated our call to action, one of the foundational components is trusted partners. We know we can’t do it alone and so we’re going to need partners along that full continuum.

What do people want from person-centered care?

Tersigni: We’ve done a lot of focus groups over the last few years as we’ve refined our strategic direction, and they revealed four different areas. They want us to respect them, they want us to include them, they want us to connect them, and they want us to engage them. They say: Respect me. Those who care for me know me, understand what’s important to me and treat me with respect and communicate in a way that I can understand. They say: Include me. Those who care for me actually are listening to me, include my family and others I trust in my care, and work as a team in providing care that’s holistic — body, mind and spirit. I want to be connected to reliable health information that’s relevant to me and networks of people like me. People with chronic diseases want to be socially connected with other people who have those same chronic diseases so they can have a social dialogue in terms of what’s happening in their lives. The last piece is: Engage me. I engage in the decision-making with my trusted partners. Those are the four goals that we’ve been trying to achieve in the voice of the customer. It’s really all about creating a healthier community.

What is Ascension’s eventual destination point?

Tersigni: Our destination point is to develop the capabilities to take care of millions of lives from birth to death. That’s what person-centered care is all about; that’s what our call to action was when we created it; and that’s where our growth is focused. The bottom line for me is, while we’ve made great strides in accomplishing our call to action, our job is not done. We still have more to do in promising the communities we serve health care that works, health care that’s safe and health care that leaves no one behind.

The Short-Term Thinking on Medicare That Can Cause Long-Term Problems

May 07, 2015
1:06 pm

It was very encouraging, to say the least, when Republicans and Democrats in Congress worked together this spring to pass legislation bringing much-needed reform to the Medicare physician payment system.  It gives hope that bipartisanship can continue to reign long enough for Washington to take on an even bigger challenge – strengthening Medicare’s long-term financial solvency.

As Jim Pethokoukis wrote this week on the American Enterprise Institute’s blog, this effort won’t be helped if those running for president in 2016 distort the issue of Medicare sustainability with their rhetoric.  One recently-announced candidate on the Republican side is, in fact, making opposition to Medicare reform a centerpiece of his messaging, saying “Washington has done enough lying and stealing.  I’ll never rob seniors of what our government promised them and even forced them to pay for.”

That kind of statement – and it’s a sentiment heard all too often on both sides of the aisle – either ignores or obscures certain unavoidable facts:

•    In blustering that you won’t “rob seniors” by improving Medicare, you’re essentially planning to rob younger generations, by forcing them to help finance a program that will be in far worse financial shape when it’s their turn to utilize its benefits.

•    You can’t pretend demographic realities don’t exist.  Today, that average senior who paid $500,000 in payroll taxes for Medicare and Social Security over his or her working life is receiving more than double that in benefits.  At the same time, the ratio of working Americans to retirees is rapidly shrinking.

•    Some of the more innovative and promising Medicare reform proposals have nothing to do with ‘robbing’ seniors, but rather providing them a choice of conventional fee-for-service Medicare or letting them enter a program similar to the popular Medicare Part D prescription drug program, in which private plans compete on the basis of cost, quality and value.  The Congressional Budget Office has said, in fact, that this approach would reduce costs for both beneficiaries and taxpayers.

Congress has already made great strides this year in improving the way Medicare operates.  The next step is to put in place the structural improvements to keep the program healthy for generations to come.   I’m under no illusion that will happen in the upcoming 2016 campaign cycle.  It would be nice, though, if we could at least have a productive, honest conversation on the subject.

Why the Roe-Sanchez Bill Matters

May 06, 2015
10:27 am

Thanks to the healthcare industry’s success in containing per-capita Medicare cost increases, it’s easy to make the case that there’s no urgency to repeal the Independent Payment Advisory Board (IPAB).  Current cost trends are not going to trigger IPAB’s power to recommend harsh cuts to Medicare expenditures, and the President hasn’t even appointed a nominee to the board.

That’s why this is exactly the right time to erase an ill-conceived idea off of the board.  Better now than when its destructive consequences are on our doorstep.

U.S. Representatives Phil Roe (R-TN) and Linda Sanchez (D-CA), joined by 220 additional cosponsors, have introduced the Protecting Seniors’ Access to Medicare Act, a bill that would repeal the provision of the Affordable Care Act which created this board of political appointees with unprecedented powers.  In addition to having the support of a majority of the U.S. House, over 500 national and local organizations representing healthcare providers, patients, employers and veterans have signed a letter urging Congress to enact IPAB repeal.

This critical mass of bipartisan support exists because IPAB is, quite simply, a bad idea.  Not only does it shift congressional authority to an unelected board, but the legislation creating IPAB prohibits judicial or administrative review of the board’s actions.  And with IPAB structured so that cuts to Medicare must be enacted within a one-year timeframe to meet spending targets, it means that long-term reforms to improve Medicare value and sustainability will take a back seat to short-term cuts to providers that will reduce beneficiaries’ access to care.

There is a need to make Medicare more cost-effective and there are ways to do it that warrant discussion.  Granting sweeping powers, however, to a board that is not responsive to the public and taking actions that reduce patient access at a time when the Medicare-eligible population is rapidly increasing are approaches we shouldn’t be pursuing.

We’re fortunate that IPAB hasn’t yet been implemented.  Congress should rapidly approve the Roe-Sanchez bill before it is.

Dr. Murthy’s Mission

May 01, 2015
2:25 pm

Last week, Dr. Vivek Murthy, the new U.S. Surgeon General was officially sworn into office.  In his speech to the ceremony attendees, Dr. Murthy described his mission for a stronger and healthier America.  He discussed roadblocks to better population health such as a culture focused on treatment rather than prevention, the spread of incorrect health information and unhealthy behaviors that are entrenched in society and difficult to change.  Addressing these issues, he said, is a shared responsibility requiring partnerships involving diverse interests and perspectives.

The Healthcare Leadership Council is proud to be a part of that partnership.  In fact, one of the Surgeon General’s first public appearances in Washington, DC was at a forum HLC hosted on anti-obesity initiatives.  At that forum, he joined with HLC member companies – Weight Watchers, Takeda Pharmaceuticals, Health Care Service Corporation and the Cleveland Clinic – to discuss the steps that are being taken to help more Americans understand the importance of and how to achieve healthy body weight.   Dr. Murthy spoke compellingly about the need to create a culture that encourages healthier lifestyles.

The good news is that important strides are being made in developing that culture.  In communities throughout the country (note Oklahoma City’s collective million-pound loss spotlighted at the HLC anti-obesity event), we’re seeing successes in establishing improved health and well-being.   Healthcare companies, including many of our HLC members, are taking innovative steps to incentivize better nutrition and exercise habits.  Many of these success stories are detailed in our publication, The Future is Here: Transforming American Healthcare Through Private Sector Innovation.

The need for progress is great.  As was mentioned several times at our recent event, the percentage of Americans classified as obese has nearly tripled since the 1960s.  This is taking an enormous toll not only on our well-being as a society, but also on the economic sustainability of our healthcare systems.   We need to learn from the successes that have been established, and then build on them.   On that note, we’re certainly aligned with our new Surgeon General.