Archive for the 'Debra Ness' Category

Pioneer ACOs: Moving Toward Needed Transformation In Health Care

Published on December 27, 2011 in Debra Ness and William Kramer. 0 Comments

Debra Ness, President, National Partnership

Cross-posted from Health Affairs Blog

We have commended the Centers for Medicare and Medicaid Services (CMS) on this blog in the past for actions regarding Accountable Care Organizations (ACOs) – but we’ve also noted the need to establish strong enough criteria to ensure that this new model will be implemented in ways that deliver on the promise of better coordinated, more patient-centered care that gives us improved value for our health care dollars. 

That is why we applaud the launch of the Pioneer ACO program by the Center for Medicare and Medicaid Innovation (CMMI).  It exemplifies the kind of innovation and testing we need to forge a path out of the current dysfunctional system.

William Kramer, Executive Director for National Health Policy, PBGH

Certainly, the nation has few higher priorities than to leave behind a health system that often fails to coordinate patient care, bringing poor clinical outcomes, miserable patient experiences, duplication, waste, errors and skyrocketing costs. The financial security of families and the economic viability of our nation depend on replacing the current payment system, which rewards volume of services regardless of whether those services are appropriate or beneficial to patients.

We need a fundamental transformation, and Pioneer ACOs have the potential to significantly change the way providers coordinate, collaborate and share accountability for the patients they serve.   But the true test of whether these ACOs deliver on their promise will lie in both the spirit and specifics of how they are implemented.

The Pioneer ACOs improve upon the Medicare Shared Savings Program announced in October in a number of ways that can more quickly advance the transformation we need:

  • It has stronger financial incentives – e.g., a higher level of shared savings and risk that can move us more quickly away from fee-for-service to population-based payment to strengthen accountability for both quality and cost.
  • Requirements for the meaningful use of electronic health records (EHRs) by the majority of the ACO’s primary care providers will spur more rapid adoption of EHRs which, in turn, should facilitate care coordination across providers and settings, help clinicians improve patient outcomes, and enable patients to engage more actively in their care.
  • It encourages public-private alignment.  We agree with the CMMI that ACOs will be more successful if the participating providers see this as their core business strategy rather than as a siloed experiment limited to a select group of patients.  The requirement for Pioneer ACOs to enter similar contracts with other payers (such as commercial insurers, employer health plans and Medicaid) reinforces this.  It is important, however, that CMS not allow the “good faith effort” exception to be used to avoid this alignment.
  • The emphasis on prospective identification of ACO patients, where feasible, will enhance providers’ ability to track, assess and improve the care they deliver to patients in their ACO panels.

As important as these requirements is the strong emphasis on patient-centered criteria and accountability to a meaningful set of quality metrics that include patient experience of care.  The assessment of patient experience is essential to determining whether ACOs ultimately deliver better care and outcomes from the patient perspective.

Furthermore, the inclusion of both a patient representative and a consumer advocate on the ACO governing board is critical to ensuring that ACOs are dedicated to serving the needs of their communities and putting patients first as they redesign the care delivery process.  We cannot truly achieve a patient-centered system unless we involve patients and consumers in the governance and design process—right from the start.  Patients have a unique perspective that comes from being the only person at the interface of all facets of their care.  They are the best judges of whether the care they get is well coordinated, meets their needs and enables them to maximize their health.

Experienced consumer advocates can be key allies in ensuring that ACOs are serving and improving the health of all segments of a community.  They can also facilitate consumer education and engagement in this new model of care.

It’s too soon to predict the impact of ACOs, and there is also a need to remain vigilant—especially with respect to the potential for Pioneer ACOs to increase the market concentration of existing large health systems and to use their market power to raise prices or engage in anti-competitive conduct.

But there is cause for encouragement.  We think the Pioneer ACOs will be on the right track to realize the promise of better care and better value for our health care dollars.  If that proves to be right, our nation will be much better off.

The Imperative for Caregivers to Speak Out and Help Shape Policy

Published on November 21, 2011 in Debra Ness. 0 Comments

Debra Ness, Leader, Campaign for Better Care

Too often, being a family caregiver is like running an obstacle course: carrying medical records from doctor to doctor, carving out time to attend medical appointments and trying to be sure that you fully understand your loved one’s needs, juggling care for a relative while trying to meet your own job and family commitments. It’s hard and often frustrating work, and it’s led thousands of family caregivers to become activists who are using their experiences to shape health reform implementation.

To harness the power of these powerful activists, the National Partnership for Women & Families joined with Community Catalyst, the National Health Law Program and The Leadership Conference on Civil and Human Rights to create the Campaign for Better Care. With generous funding from The Atlantic Philanthropies, the Campaign is working with patients and family caregivers to ensure that health reform has a broad and lasting impact. The goal is to significantly improve the way we deliver health care so the system finally works for the most vulnerable among us – older adults, patients with multiple chronic conditions and their family caregivers.

With support from organizations like the Family Caregiver Alliance and the Campaign for Better Care, patients and family caregivers from across the country are advocating at the federal and state levels more than ever. They are insisting that new models of delivering care be truly patient- and family-centered. They are calling for team-based and multi-disciplinary approaches that include important services that have not been readily available to many: geriatric assessment, care planning, comprehensive care coordination, transition management between care settings, medication management, and community support for older adults and their family caregivers.

At the same time, in Washington, D.C. we are doing the hard but important behind-the-scenes work to ensure that the Affordable Care Act (ACA) is implemented in ways that meet the particular needs of vulnerable older patients, and make quality, affordable, coordinated health care a reality for families.

By sharing their personal experiences, family caregivers play a compelling and essential role in influencing policy and public opinion. They are telling the stories that underscore the problems in our health system today, and how the decisions made in Washington affect people’s lives. In doing so, caregivers are helping to move our nation closer to the day when essential health services are covered, when preventive care and community based support and services are priorities, and when care is truly coordinated. By speaking out about their own unmanageable burdens, caregivers hasten the day when others families will have fewer of these burdens to bear.

The ACA contains the key ingredients to transform our health care system from one that is shaped by the interests of providers and payers to one that is dedicated to the needs of the patients, and to providing the services and supports that they and their families need. This is long overdue. What this law promises is what the nation needs most: doctors who talk to one another, medical records at our fingertips, and a system that is built around addressing the needs of patients and families. Its real promise is a health care system in which caregivers and the people they care for no longer have to fend for themselves in an uncoordinated and fragmented system.

This month, as we mark National Family Caregiver Month, the U.S. Supreme Court announced that it will soon consider whether to let stand key provisions of this landmark health care reform law. There’s a lot at stake – in Congress, the courts, and at the community level as this national conversation continues. That makes it more important than ever that this month –and every month –caregivers speak out about the imperative to make the health care system work for all of us.

What we do – and don’t do – to address the caregiving challenges will families today and in the future, and it will affect our strength, competitiveness and health as a nation for years to come. The time for action is now.

Cut Medicaid? Thanks, But No Thanks!

Published on November 21, 2011 in Debra Ness. 0 Comments

Debra Ness, Leader, Campaign for Better Care

Thanksgiving. It’s a time for family, food and giving thanks especially for programs – like Medicaid – that make a difference in the lives of millions of American women and their families.

Women make up the majority of enrollees in Medicaid.  For younger women Medicaid provides essential preventive and primary care.  And for millions of older women,  Medicaid provides coverage for long-term care services –including nursing home coverage – that Medicare does not provide.  If lawmakers arbitrarily cut Medicaid, these cuts could jeopardize nursing home coverage, making it extremely difficult — if not impossible — for states to meet the needs of the growing number of vulnerable older women who need help to pay the impossibly high costs of nursing home and other long-term care. And tougher limits on eligibility or reduced coverage for services means that many older women could face dramatically higher out-of-pocket spending for the health care and nursing home services they need.

Put simply: deep cuts to Medicaid funding will disproportionately harm older women, and could have disastrous consequences for many of the most vulnerable people in our country.

 Please tell Congress: Cutting Medicaid is not the solution!

Welcome Progress, But the Final Verdict on ACOs Is Yet to Come

Published on October 28, 2011 in Debra Ness and William Kramer. 0 Comments

Debra Ness, Leader, Campaign for Better Care

Last week, the Centers for Medicare and Medicaid Services (CMS) may have done what once seemed impossible. Its final rule on Accountable Care Organizations (ACOs) seems to have put an end to the rancor and bitter debate on this particular issue, shaping a framework that just about all parties can accept.

By responding thoughtfully to comments on the proposed rule, and balancing competing interests, the agency has given us a welcome respite from the pitched battles that are raging over so many aspects of health reform. But the real measure of success will be whether successful ACOs are soon in place, providing better-coordinated, more patient-centered care for millions of patients and giving us all a way to get better value for our health care dollars.

William Kramer, Executive Director for National Health Policy, PBGH

We believe last week’s announcement will encourage more providers to participate in this program. From the perspective of consumers, we applaud the strong emphasis on patient-centered criteria that should pave the road to better care. And especially as advocates for our oldest, sickest and highest risk patients, we applaud this

effort to incentivize better primary care, increased coordination, and shared accountability across providers. From the perspective of purchasers, we believe that CMS has crafted a foundation to hold providers accountable for quality performance and cost savings, and created a path to move providers away from today’s perverse fee-for-service system.

We are very pleased that this final rule will require ACOs to use beneficiary experience of care and outcome measures to evaluate performance. We believe CMS landed in a better place with respect to the quality measures ACOs must report on. While we appreciated the comprehensiveness of the original list of 65 measures, there were a number of measures that added minimal value. The final list of 33 measures is a stronger set that focuses on highest impact measures and, very importantly, includes measures of patient experience, functional status and clinical outcomes, care coordination and safety. We would, however, have liked pay-for-performance to occur sooner in the program, especially for measures that are already in use. Finally, we are very pleased that this final rule continues to ensure full transparency, notification and choice for beneficiaries. These provisions are all essential to engaging consumers in a positive way and realizing the promise of successful ACOs.

Nobody got everything they wanted in the final rule and we, too, have concerns. We are disappointed that the upfront anti-trust review process is no longer mandatory, but glad there is strong acknowledgement that there must be close monitoring for any signs of cost-increasing market concentration. We are glad to see that the final rule requires CMS to share ACO applications and new types of data that will strengthen the ability of the Federal Trade Commission and Department of Justice to assess and monitor the market impacts.

It is also unfortunate that the provisions requiring beneficiary participation on ACO boards have been tempered, rather than expanded to include representation from a diverse range of community stakeholders, including purchasers, labor and community-based groups. It is now incumbent on CMS to closely monitor ACOs to ensure that they reflect the community interests they are intended to serve, and that consumers, beneficiaries and other key stakeholders are engaged in the design, governance and evaluation of their performance. Consumers and purchasers hope and expect that these provisions will be strengthened down the road if needed.

Every leader from every sector has a list like this – things they like, and things they don’t like, in the final rule. But the time for tallying who won and who lost, and by how much, is over. Now it’s time for all parties to come together to create successful ACOs that deliver care that is patient-centered, that improves quality and care coordination, and that lowers costs. The stakes are too high to let anything stand in our way, or to let opponents of reform exploit any remaining differences.

We said before this rule was released that it’s time for a new dynamic where we come together to implement the reforms the nation so urgently needs. ACOs are one of many promising models and initiatives that will be tested by the CMS Innovation Center over time. It is well past time to leave our broken, dysfunctional health care system behind and give the Accountable Care Organization model the test it deserves.

The final rule gives us a chance to do that. That’s all we could ask. CMS has done its part. Now it’s time for the rest of us to do ours. If we do, patients, their families and family caregivers, our economy and our nation will benefit.

Debra L. Ness is Leader of the Campaign for Better Care and President of the National Partnership for Women & Families. William Kramer is the Executive Director for National Health Policy at the Pacific Business Group on Health. Together, they co-chair the Consumer-Purchaser Disclosure Project, a group of leading employer, consumer, and labor organizations working toward a common goal: to ensure that all Americans have access to publicly reported health care performance information.

Cross-posted from the Health Affairs Blog.

Seniors in America Today: “Not a Pretty Picture”

Published on May 12, 2011 in Debra Ness. 0 Comments

Debra Ness, President

Earlier this week I was privileged to be a part of Volunteers of America’s third annual discussion on aging issues. I was on a panel with Arianna Huffington, Huffington Post co-founder and editor-in-chief; Mike King, National President and CEO of Volunteers of America, Inc.; and Lorraine Cortés-Vázquez, AARP Executive Vice President of Multicultural Markets and Engagement. Our topic: How our nation’s public policies affect older Americans, especially women. Medical journalist and best-selling author Dr. Bob Arnot moderated the discussion, which addressed how to improve the U.S. health care system, how women can best prepare for old age and care for their loved ones, and how we can press for better coordinated care that lessens the burdens on family caregivers.

During the panel, I talked about the work of the Campaign for Better Care to improve care for the oldest and sickest patients, and described the good-news-bad-news reality of women aging in America. The good news is that women are living longer. The bad news is that they are living poorer and sicker. And when you take a hard look – in particular at the lot of older women and their family caregivers – it isn’t a pretty picture. In the workplace, women experience persistent discrimination and lower earnings on average than men. In the workforce, they face employer policies that make it extremely difficult to be both wage-earners and caregivers. In the obstacle course that is the U.S. health care system, they are forced to jump through hoops to secure the care they need.

My fellow panelists each brought valuable, personal perspectives on caring for the aged. Arianna Huffington talked about the cultural issues involved, as well as the distinct joy she derived from caring for her own late mother. Mike King seconded those sentiments, adding that caring for his mother was an honor.

Lorraine Cortés-Vázquez stressed that we need to educate ourselves to better prepare for aging, and create livable communities that offer long term care services. She also raised an issue that doesn’t get nearly as much attention as it should: the fact in that in some underserved communities, doctors’ offices are vanishing, forging an even stronger link between poverty and poor health.

We also discussed the current debate about the federal deficit. I wanted to stand up and cheer when Mike stated a principle that we all should embrace: “We’re not going to balance the budget on the backs of the older Americans who built this country. It’s not fair. We have to stand up and say that.”

Some time after Mike made that statement of conscience about what we must not do, a woman in the audience asked a great question about what we should do. What kind of strategies can we employ, she asked, to advance change in Congress? I told her what I believe: that one way to influence lawmakers and policymakers is through the Campaign for Better Care. We launched this nonpartisan campaign last year to organize Americans across the political spectrum to make their voices heard. By recounting their real-life struggles in the U.S. health care system, members are giving policymakers both the incentive and the information needed to create change. Older women and their caregivers desperately need a health care system that delivers timely, coordinated, appropriate, affordable care. The Campaign is focused on changing our health care system so that the oldest and sickest patient can get this kind of care and live in their communities for as long as possible.

I commend Volunteers of America for organizing such a fantastic discussion. In preparation for this week’s event, Volunteers of America commissioned a nationwide survey to find out how the elderly and their caregivers are faring during these tough economic times. Its white paper on the findings – “Boomer Bust 2011: Still Unprepared and Unaware” – is well worth reading, and passing along. If you weren’t able to attend the panel, an archived webcast of it is available here.

Do hospitals make you safer or sicker?

Published on May 2, 2011 in Debra Ness. 0 Comments

Debra Ness, President, National Partnership

1.7 million infections associated with health care. 100,000 deaths caused by medical errors. Millions of patients readmitted to hospitals because they didn’t get follow-up care. And billions of dollars wasted.

For too many people, the reality is that you can actually get sicker during a hospital stay — and the problem goes a lot deeper than all the germs lurking on doorknobs, counter tops and railings. The crux of the problem is that, too often, your care is neither safe nor well-coordinated.

This means, if you’re admitted, you have to repeat your health history every time the shift of doctors and nurses rotates. This means your health information isn’t always shared, your doctors don’t always talk to one another, mistakes happen and errors occur.

And when you’re discharged, you risk becoming a statistic — such as 1-in-5 hospitalized Medicare patients are back in the hospital within 30 days — if you don’t receive the information and resources you need to stay healthy. Now imagine what it’s like for the most vulnerable patients — older adults with multiple health problems. It’s intolerable and even dangerous.

The good news is we already know many ways to fix our nation’s hospitals. In fact, more than 800,000 of the more than 7 million 30-day hospital readmissions annually could actually be prevented – and

some hospitals and models of care already have good practices in place and are available in some areas. But the problem is they aren’t available everywhere and for everyone. This must change.

That’s why we’ve launched the Healthy Hospital Initiative, a national movement of patients demanding better care at the bedside and beyond. Join us! Find out if your local hospital is getting healthier – and then add your name to our Healthy Hospital petition urging your hospital to provide better care. Because you and your loved ones deserve to experience better, safer care in times of need!

It’s Time to Move Forward

Published on March 23, 2011 in Debra Ness. 0 Comments

Debra Ness, President, National Partnership

This week marks the one-year anniversary of the Affordable Care Act, and millions of Americans are already benefitting from our new health reform law.

In the months ahead, even more of us will benefit if it improves care coordination, provides more preventive services, and makes coverage more affordable and secure.

It only gets better from here. That is, if we give reform time to work — and work together to make sure it gets implemented effectively.

Together, we’re working to build better care — care that is better coordinated, more centered on meeting the needs of patients, and more affordable. That’s why we encourage the Senate to stand strong against efforts to repeal or defund health reform.

It’s time to move forward and fix our health care system.

We simply can’t afford to let anyone undermine our efforts to make America’s health care system work better for all of us — and especially for older adults, patients with multiple chronic conditions and their family caregivers.

Just ask Leslie Schlienger, a nurse from south Florida, who is working on the front lines.

Since graduating from nursing school in 1980, Leslie has been a head nurse in Veterans Administration and community hospitals, earned her certification in rehabilitation nursing and her master’s degree in nursing administration. For the last dozen years she’s been a home health nurse, and a critical part of her work is coordinating clients’ care with family, friends and medical professionals.

“The fragmentation of how care is delivered is a big issue,” Leslie says. “Because of all the specialties, a single patient often has two or three physicians, and I’ve seen some with as many as seven or eight. Patients are overwhelmed by that. They’re lost in that system.” (Read the rest of Leslie’s story here.)

Now more than ever, we need better care coordination, improved communication among providers, medical records at our fingertips, and a system that doesn’t leave vulnerable patients and their family caregivers to fend for themselves.

To mark the one-year anniversary of the Affordable Care Act and honor the millions of Americans working every day for better care, urge your Senators to focus on fixing our health care system and reject any attempts to repeal or defund health reform.

I’ve already sent my message to Congress. Please send yours today!

State of the Union: Let’s Keep the Conversation Going…

Published on January 26, 2011 in Debra Ness. 4 Comments

Debra Ness, President, National Partnership

Last night, President Obama delivered the annual State of the Union address.

While the speech focused primarily on jobs, competitiveness and the economy, the President also took time to talk about the ways the Affordable Care Act is already helping some of the people who need reform the most.

“If you have ideas about how to improve this law by making care better or more affordable, I am eager to work with you. …Let’s fix what needs fixing and move forward.”

Now, all week long, you have a great opportunity to keep the conversation going.

There are many ways to stay engaged, and we want to call your attention to three in particular.

  • Right now, you can tweet questions to Press Secretary Robert Gibbs. A special guest will answer them before the post-State of the Union press briefing. More »
  • Tomorrow, you can join a live roundtable discussion with Health and Human Services Secretary Kathleen Sebelius on Facebook. Submit your questions now or during the event. More »
  • Tomorrow, you can also watch a live interview with President Obama on YouTube. More »

We encourage you to get involved and use one of these channels to speak out.

This is a great opportunity to voice your support for the Campaign for Better Care and to ask critical follow-up questions about how health care reform can be implemented in ways that provide the care coordination and improved communication we all need.

For example, there are some strong new models of care being piloted. (To learn more, watch these videos  on Independence at Home, Guided Care, and PACE.)

Ask the Administration when these new programs will be available in your community.

Drop us an email and let us know which questions you submit. And we’ll join you on Twitter, Facebook, and YouTube to speak up on the urgent need for better care.

A Seat at the Table

Published on November 16, 2010 in Debra Ness. 3 Comments

Debra Ness, President, National Partnership

Today, I was thrilled to represent the Campaign for Better Care – and speak on your behalf – at the official launch of the Center for Medicare and Medicaid Innovation (Innovation Center).
Created by the Affordable Care Act, the Innovation Center will examine new ways of delivering health care and new ways of paying health care providers that can improve health care quality and save individuals and the system money.
For those of us who want better coordination, better care and better outcomes for patients, today’s launch is good news indeed. The launch of the Innovation Center also came with an announcement that major new projects are being launched in communities around the country that will bring care coordination to people with Medicare and Medicaid coverage who struggle with multiple chronic conditions.
The message is simple: Help is coming to those who need it most.
The Innovation Center is charting a path to a new kind of care—the kind of coordinated, patient-centered, affordable care every American deserves—and as a member of the Campaign for Better Care, you are helping to make it happen.
Today, I am encouraged. But if we want to realize the promise of the Innovation Center, we have to be sure to build the new models of care right – right from the very beginning – and ensure that patients and their families continue to have a seat at the table.
This is what the Campaign for Better Care is all about – and with your help, and a lot of hard work, every patient should eventually experience better care and better care coordination.

Read more »

Where Are We Now? Six Months After Health Reform There is Much to Celebrate…And Lots of Work Ahead

Published on September 23, 2010 in Debra Ness. 11 Comments

Debra Ness, President, National Partnership

Six months ago today, President Obama signed the health care bill into law.  And with his signature, our health care system was opened up for renovation. But, like any remodeling job, we’ve got a long way to go before the final product will be ready for a ribbon cutting ceremony.

So, why is the six month anniversary of the Affordable Care Act important?  Because today some key provisions in the law go into effect – and that means it’s time to take stock of where we are and where we’re going. Meaningful implementation of the health reform law – implementation that focuses on what’s best for patients and families – in the months and years ahead is critical.  But there is already much to celebrate.

Consider that we’ve already seen important patient protections put into place so that insurance companies can’t deny or drop your coverage based on your age, gender, or pre-existing conditions. And, starting now, any new private health plans will cover the full cost of preventive health services like cancer screenings. On January 1st, cost-sharing for preventive services under Medicare will be eliminated.  This means people will be able to access the most basic health care – the kind of care that can help identify disease early or prevent it altogether.

Today we can also celebrate the first steps towards improving care coordination and rewarding good primary care. The Afffordable Care Act increases payment for primary care providers in Medicare and Medicaid which will help ensure that patients have better access to primary and preventive care. The law also lays the groundwork for improving coordination of care by testing new and innovative approaches to delivering health care to promote higher quality, improve communication and collaboration among providers, ensure safer and smoother transitions when patients move across different settings of care, and provide more time, support and information for patients and family caregivers. It also supports medication management services to reduce adverse interactions and medication errors — which will especially help patients and families who are managing multiple chronic conditions.

These improvements, coupled with the funding for improving health care through better health information technology (IT) under the stimulus package passed in January of 2009, will create better patient outcomes and reduce costly duplication and waste.

And just as these new policies are being put into place, longer-term strategies required by the new law are being developed and rolled out. Just last week, the Obama Administration issued a core element for the implementation of health reform:  a national strategy for health care quality improvement. The National Partnership for Women & Families and the Campaign for Better Care are at the table and ready to help shape this important strategy to make sure it truly meets the needs of patients and consumers.  In the end, we’re hopeful that this new plan will help reduce health disparities, increase positive health outcomes, and improve patient and caregiver experiences in the health care system.

We’re off to a good start, but our efforts to make the health care system work for patients and families are just beginning. When doctors can spend enough time with their patients – and when they talk to each other to manage our care better – we will all benefit.  We will be less likely to experience bad drug interactions or unnecessary and duplicate tests.  Our medical records will be at our fingertips – and available to our health care providers so that they have the whole picture when treating us. We will be less likely to suffer from preventable medical errors that can result in injury or even death.  And we won’t have to fend for ourselves or our loved ones in an uncoordinated and fragmented system.

These things are the foundation of a good health care system and, ultimately, a healthy population.  It will take some time – as any renovation does – but in the end it will finally get us to a health care system that delivers the comprehensive, coordinated, high quality care that everyone deserves.