Home

Calls to Repeal the Independent Payment Advisory Board Persist

October 04, 2017
1:08 pm

Amidst the uncertain healthcare environment Americans face, there is a threat that has remained constant: the implementation of the Independent Payment Advisory Board (IPAB).  IPAB, once triggered, will impose significant cuts in the Medicare program that will affect beneficiaries’ access to healthcare. The efforts to repeal IPAB have involved almost 800 organizations across the United States that recognize the dangers of having a single entity with such unprecedented and unchecked authority.

One of the partner organizations taking a stand against this board is the Better Medicare Alliance (BMA).  The BMA mission is to create a healthy future for the nation’s seniors, and ensure innovative, quality healthcare.  Allyson P. Schwartz, President and Chief Executive Officer of BMA and former U.S. Representative from Pennsylvania, wrote an op-ed in The Hill that highlights the bipartisan support of IPAB repeal.

The op-ed is shared below, and the link is provided here.


Congress needs to repeal the Independent Payment Advisory Board

By Former Rep. Allyson Y. Schwartz (D-Pa.), opinion contributor

Now is a particularly difficult time to enter into any debate on health care in our country without the expectation of strong partisan divide. However, there is an opportunity that has bipartisan support and a need for action right now.

When I served in Congress, I was actively involved in the development and passage of the Affordable Care Act (ACA). I fought to be sure it met a number of goals, one of which was to reduce costs in health care through improving access to coverage, focusing on primary care, early treatment of disease, and numerous ways to encourage care to more cost effective for government and affordable for consumers.

I am proud of the important work that is the result, bringing changes right now across the country in doctors offices, hospitals, and community care to improve quality and bring down costs in Medicare.

However, not everyone was convinced that all the efforts underway now would happen or happen fast enough. To be sure costs could not grow faster than inflation, the Senate added a provision in the ACA hat many of us thought, even at the time, was the wrong way to bring down costs.

In fact, I was one of the first Democrats to publicly oppose the creation of what is called the Independent Payment Advisory Board (IPAB) and I supported Republican legislation to repeal it. IPAB repeal is now a bipartisan effort, but it has not been taken up or passed. And time is running out on a chance to stop it.

Here is how IPAB is supposed to work and why it is a bad idea.

IPAB is a board appointed by the president, with the sole authority and responsibility to cut Medicare. They are accountable to no one. If costs in Medicare rise above a certain level of inflation, cuts to bring those costs have to be made and implemented in one year. The law also says that if the President does not appoint this Board, then the Secretary of Health and Human Services has the sole discretion to make these cuts. New revenues or other actions to cover costs are not an option.

Why is this a problem for Medicare and the 55 million beneficiaries who rely on it?

Neither IPAB nor the Secretary of HHS is accountable to the voters. Given the importance of Medicare and the potential impact, our elected representatives should be involved in making this kind of major decision about Medicare. Second, the cuts have to be made in all in one year. Estimates of potentially as much as $1 billion in cuts in 2019 would mean everyone could be affected. Third, there is no requirement that the cuts be done in a way that improves care or targets waste or inefficiencies. If these cuts are across-the-board cuts, they cut important services including new innovations happening to reduce costs in the right way.

While beneficiaries are not supposed to be hurt, there could be cuts to payment to doctors or to innovative programs like telemedicine, nurse care managers, or care in the home —all of which could have a negative impact on Medicare beneficiaries.

This is not only unwise, it is unnecessary. Medicare is in the process of transitioning from the outdated and inefficient fee-for-service payment structure to one that pays for value. New payment systems are underway that focus on high-value treatments, therapies, and interventions that promote better outcomes. We should be doing all we can to drive these positive changes in Medicare, particularly for those with chronic conditions.

The success of this kind of care is evident in the achievements in Medicare Advantage, which is a public-private partnership that is driving innovations and tailored services for millions of beneficiaries through care coordination, supplemental benefits, and patient engagement.

IPAB won’t help any of this important work and is potentially destructive both to these positive efforts and to Medicare.

Congress needs to act and repeal IPAB this year.

I am proud to have built a strong bipartisan consensus on Capitol Hill to oppose IPAB. Now, as I work to strengthen the innovations in payment and care delivery that bring the promise of better, cost effective care for Medicare beneficiaries, I ask Republicans and Democrats to act on their bipartisan agreement that IPAB should not be implemented. Millions of Medicare beneficiaries will be grateful that you took action to stop this harmful and unnecessary idea from being a reality.

Allyson P. Schwartz is President and Chief Executive Officer of the Better Medicare Alliance and is a former U.S. Representative from Pennsylvania.

Medicare Embraces the ‘Ounce of Prevention’ Philosophy

March 23, 2016
5:20 pm

We’ve long maintained that Medicare can be a stronger program, both in terms of protecting the health of its beneficiaries and in improved cost-efficiency, if it did a better job emphasizing prevention, diagnosis and early treatment, emulating many of the lessons being demonstrated every day in the private sector.

To the credit of HHS Secretary Sylvia Burwell, the Medicare program is now moving in this direction in a very significant way.

Today, Secretary Burwell announced that the Obama Administration will propose new rules this summer that would have Medicare provide coverage for diabetes prevention programs.  She cited a YMCA program that has enabled participants to cut their body weight by an average five percent, thus reducing the propensity for diabetes, a disease with extremely high incidence rates among the elderly.  Early interventions can prevent the need for more expensive healthcare services to treat diabetes symptoms, thus reducing Medicare expenditures.

HLC has long argued that Medicare should pay for services such as health coaching, aiding beneficiaries in practicing better dietary and exercise habits, as well as new technological innovations to help those with diabetes and prediabetes better monitor their health conditions.  We, in fact, sponsored a briefing for congressional staffers on the subject last year.

Secretary Burwell’s announcement today heralded an important new direction for the Medicare program.  In her words, the federal government is transitioning from “treating the sick to preventing the illness.”   We applaud her actions.

The Proliferation of Progress Generated by Medicare Advantage

December 11, 2015
3:20 pm

This week the Blue Cross Blue Shield Association, representing plans that serve over four million individuals in Medicare Advantage and Medicare Part D prescription drug plans, hosted a congressional briefing to discuss innovations in Medicare Advantage.    Experts shared abundant evidence that Medicare Advantage plans have risen above and beyond traditional Medicare in providing quality healthcare that is cost-effective.

Several case studies were presented that highlighted continuing improvements being made to improve senior health:

  • Care at Home, a service launched by BCBS of Western New York and Landmark Health, offers a team that does not replace the primary care physician, but rather collaborates with the doctors and stays apprised on how patients are faring in their own residences.  Care at Home has enrolled 2,500 seniors since November 2014.  Patients with multiple chronic diseases generate more than seven times the healthcare costs of patients with only one chronic disease.  Medicare Advantage members who have six or more chronic diseases are eligible for Care at Home.  The coordinated care, which includes nurturing and education family caregivers, has, thus far, helped prevent 617 emergency room visits.
  • CareMore Health System, an Anthem company, uses doctors called extensivists to coordinate care for patients with chronic conditions.  They also ensure that there is proper follow up with patients and that protocols are adhered to by all involved in the patients’ care.  Predictive modeling is utilized to determine risk and practice early intervention, helping to keep costs low.  An average day at CareMore includes visits to homes for social and behavioral support, reading results from monitors in patients’ homes, following up after discharge, and providing rides for patients who have no form of transportation to reach points of care.
  • BCBS of Rhode Island identified pharmaceutical management as a way to lower healthcare costs and improve health outcomes.  The patient- centered pharmacy program serves members with multiple chronic conditions who take at least four medications and spend over $3,000 on drugs.  The medication therapy management includes comprehensive medication reviews, prescriber consultations, counseling for adherence and education, and monitoring to ensure good adherence habits are established.  In just the first three quarters of 2015, 8,632 members were served with an estimated savings of $2.8 million.

These are just a few examples demonstrating how innovation in Medicare Advantage has protected patients from high out-of-pocket costs, maintained quality care, and kept consumer satisfaction levels high.  These individual successes, and the others like them, need to be kept in mind by policymakers when they debate future support for the Medicare Advantage program.  The best practices and outcomes achieved by these pioneers in healthcare should be shared and encouraged so they can be replicated across the country.

Documenting the Better Care, Lower Cost Advantages of Medicare Advantage

September 03, 2015
11:59 am

A study published in this month’s edition of the American Journal of Managed Care brings hard data to an argument many of us have been making for some time, that private Medicare Advantage plans are doing a superior job of delivering high-quality care at less cost than traditional Medicare.

The study, led by Dr. Bruce E. Landon of the Harvard Medical School and funded by a grant from the National Institute on Aging, examined price-standardized resource usage and care delivery for patients with diabetes or cardiovascular disease in both Medicare Advantage plans and traditional fee-for-service Medicare.  The takeaways from the study included:

•    For both health conditions examined, relative resource use was lower in Medicare Advantage plans than it was in traditional Medicare

•    Although there was variation among individual plans, quality of care for diabetes and cardiovascular disease was higher in Medicare Advantage plans.

The study concludes, “Proponents of managed care have long argued that integrated health plans can deliver care more efficiently than traditional fee-for-service care by using their ability to tailor their provider networks to the needs of their population and to implement disease and case management programs to improve chronic disease management.  In this large national study of enrollees with diabetes or cardiovascular disease, our findings suggest that many Medicare HMO health plans are able to deliver care of equal or better quality with lower (resource usage) than traditional Medicare.”

These findings, I would add, echo what we hear at the Healthcare Leadership Council on a regular basis from not only our health plan members, but also from hospital leaders – that, in terms of attacking chronic disease in a cost-efficient way, Medicare Advantage has a strong upper hand over conventional Medicare.

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.