PHA is featured in Partnership for the Future of Medicare’s 2014 Partner Perspectives

The Population Health Alliance (PHA) is featured in the latest issue of the Partnership for the Future of Medicare’s Partners Perspectives. This year’s publication compiles examples of the work that many organizations are doing to improve and innovate within the Medicare program.

PHA is proud to collaborate with the Partnership for the Future of Medicare to ensure the long-term security of the program. PHA supports the goal of strengthening beneficiary protections and encouraging coordinated, efficient, high quality care in the Medicare populations. PHA has long pursued research and policy initiatives that define and accurately measure outcomes of successful health and health care programs. We have also provided evidence-based advocacy regarding Medicare proposals.

PHA shares CMS’ goals of improving the quality of care for Medicare beneficiaries, and fully supports the agency’s quality measurement objectives. An objective Star Ratings methodology will drive better care delivery and empower beneficiaries to make informed decisions about their health care. PHA advocates administratively feasible solutions, such as embedding self-improvement into every measure and rewarding plans for outcomes.

In 2014, PHA convened a Medicare Action Coalition to protect Medicare Advantage beneficiaries from rate cuts in the 2015 rate-setting process. Our position focused on the value that 15 million beneficiaries receive through evidence-based services such as care coordination and wellness benefits that are not available under traditional fee-for-service Medicare. We provided research that demonstrated the program has proven results in better health outcomes and well-being, while reducing emergency room visits, hospital admissions and other acute health episodes. This was a broad-based stakeholder group representing consumer and advocacy groups, industry and trade associations, physicians and health systems and employers.

PHA members play a strong role in leading the industry in Medicare innovation as well as other programs that improve individual well-being and reduce health care costs. Our population health approach includes several case studies as examples of these innovations and successes.

The publication showcases several case studies that reflect PHA’s work in improving Medicare.

Read the 2014 Partner Perspectives


PHA applauds CMS’ efforts in favor of payment for non-face-to-face care coordination services


As part of its advocacy efforts on behalf of its members, on September 2, the Population Health Alliance (PHA) wrote to Ms. Marilyn Tavenner, CMS Administrator, to applaud the Centers for Medicare and Medicaid Services’ (CMS) efforts to improve care for beneficiaries with multiple chronic conditions by facilitating payment for non-face-to-face care coordination services.

Read the letter Re: CMS 2015 Medicare Physician Fee Schedule


If you are interested in the Population Health Alliance (PHA)’ advocacy and government affairs work, please, come on board and work with us:

Medicare Advantage Action Coalition is disappointed, concerned with CMS 2015 Advanced Notice

As part of its advocacy efforts on behalf of its members, the Population Health Alliance (PHA) has been an integral part of the Medicare Advantage Action Coalition. On March 4, the Coalition wrote to Ms. Marilyn Tavenner, CMS Administrator, to express its disappointment and concern over the Centers for Medicare and Medicaid Services (CMS) February 21st Advanced Notice.

The  Medicare Advantage Action Coalition represents several thousand stakeholders across the health care spectrum, including but not limited to, physicians, health care professionals, health plans, aging and disability groups, industry and trade associations and employers.

Read the letter Re: CMS 2015 Advanced Notice and Call Letter

If you are interested in the Population Health Alliance (PHA)’ advocacy and government affairs work, please, come on board and work with us:


PHA Letter to CMS about Proposed Rulemaking (NPRM) Medicare Program




As part of its advocacy efforts on behalf of its members, the Population Health Alliance (PHA) submitted comments to the Centers for Medicare & Medicaid Services regarding the January 10, 2014 Notice of Proposed Rulemaking entitled: Medicare Program: Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Program. We are very concerned that CMS’ proposed requirements around preferred pharmacy networks and eligibility for Medication Therapy Management (MTM) will result in increased out-of-pocket costs, clinically inappropriate care, and reduced access to high-quality pharmacy networks for the 37 Million seniors enrolled in the Medicare Prescription Drug Program (Part D).

Read the letter: Re: Notice of Proposed Rulemaking (NPRM) Medicare Program: Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Program


Get Involved! Medicare Advantage Call to Action

As follow-up to the December 17th CCA and National Association of Manufacturers (NAM) Medicare Advantage Roundtable, please join us for a meeting on February 5th from 9am – 10am EST to discuss next steps in response to the forecasted 6.5% cut to 2015 Medicare Advantage rates and other political updates!  Special thanks to our co-host Healthcare Leadership Council.

Date:         Wednesday, February 5th, 2014 

Time:       9:00 – 10:00 am EST                                

Location:  Healthcare Leadership Council 750 9th St NW Suite 500 Washington, D.C. 20001

Call in number: 877.394.9920 Conference code: 7488204719

Please RSVP for security: Vicki Shepard, or Isabel Estrada-Portales

Given the diverse multi-stakeholder nature of our group, we are uniquely positioned to communicate the value of Medicare Advantage in advocacy efforts with policymakers in CMS and on Capitol Hill. It will be important to discuss the following next steps:

  • Individual and group efforts around Medicare Advantage
    • Draft sign-on letter and timing (attached) – If you are not able to attend, and are ready to sign or have questions, please let us know.
    • Generating individual organizational letters – See the material from our last meeting and sample letters. WELCOME TO SEND NOW AND BRING TO MEETING!
    • Potential Capitol Hill visits
  • Strategy to reach out to additional stakeholders
    • Coalition Info Sheet (attached)
    • Other stakeholder groups who should be involved


Medicare Advantage Action Coalition

Sign On Letter to CMS Administrator Marilyn Tavenner

Protecting Medicare Advantage (MA) Roundtable Discussion & Call to Action

Due to the number of inquiries we received at our last meeting for a call-in number, please use the following if you cannot join us in person:

Dial-in number(s): 877.394.9920 Conference code: 7488204719

CCA and National Coalition on Health Care Joint Letter on CMS “Two Midnights” Requirement

October 31, 2013
Jonathan Blum
Deputy Administrator, Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, D.C. 20201

RE: FY2014 Medicare Inpatient Prospective Payment System (IPPS) Final Rule – Anticipated CMS Guidance on “Two Midnights”

Dear Deputy Administrator Blum:

On September 26th, the Centers for Medicare & Medicaid Services (CMS) held a Special Open Door Forum during which CMS stated that the Agency was planning to issue detailed subregulatory guidance to clarify the FY2014 Medicare Inpatient Prospective Payment System (IPPS) Final Rule’s “Two Midnights” requirement. CMS specifically stated that such guidance would address that hospital utilization review programs and conditions of participation are not changing with implementation of the Final Rule. CMS also confirmed that the IPPS Final Rule, “should not be used as a reason for hospitals to abandon their use of critical medical necessity and coverage assessments,” in public statements made by the CMS Philadelphia Regional Office. We agree that the “Two Midnights” requirement should not be interpreted as a substitute for sound clinical judgment based on objective, evidence-based medicine.

To assist CMS in issuing needed clarifying language, attached please find proposed language for inclusion in the forthcoming subregulatory guidance that CMS is currently preparing. We appreciate your continued efforts to clarify these important details regarding “Two Midnights” in order to minimize confusion and ensure beneficiaries are receiving appropriate care at the appropriate time. Thank you.


John Rother, President & CEO, National Coalition on Health Care

Frederic S. Goldstein, Executive Director, Care Continuum Alliance

Read the Letter

CCA Letter to Congressman Ryan on behalf of Medicare Advantage Beneficiaries

October 4, 2013

The Honorable Paul Ryan

Chair, Committee on Budget

United States House of Representatives

1233 Longworth House Office Building

Washington DC 20515

Dear Representative Ryan:

As the Congressional discussion of budget priorities continues, we are writing on behalf of the Care Continuum Alliance (CCA) to seek your support in assuring that the more than 14 million Medicare beneficiaries enrolled in a Medicare Advantage (MA) plan will not experience any additional cuts to the MA program, and will continue to have access to the quality care delivery, care coordination and wellness and prevention services offered by MA plans.

CCA convenes a broad range of stakeholders dedicated to enhancing the health of populations. Through advocacy, research, and education, CCA advances evidence-based population health management strategies. The CCA aims to improve care quality and health outcomes while reducing preventable costs for the healthy and those at risk of or suffering from chronic conditions. Our diverse membership of more than 200 organizations and individuals includes physician groups, nurses, other health care professionals, hospital systems, wellness and prevention providers, population health management organizations, pharmaceutical manufacturers, pharmacies and pharmacy benefit managers, health information technology innovators, employers, researchers, and academics.

Our member organizations serve Medicare beneficiaries across the country, including a large majority of beneficiaries enrolled in MA plans across the country. MA enrollees receive high quality care and enhanced services at lower costs. Of particular importance, MA enrollees often receive enhanced, evidence-based wellness and prevention services and chronic care management. These programs directly benefit America’s seniors and help reduce health care spending overall.

For example:

Medicare seniors with diabetes in a MA Special Needs Plan had 7% more primary care physician office visits and 19% fewer days in the hospital compared to seniors in Medicare fee for- service (FFS). [i]

Seniors in an MA plan had a 14.5% 30-day readmission rate from 2006-2008, which was 22% lower than FFS readmission rates.[ii]

Seniors in MA plans are less likely to report trouble in receiving care, more likely to have a usual source of care, and more likely to receive necessary preventive services compared to seniors in FFS.[iii]

Despite the measurable success of MA, the program faces challenges in 2014, 2015 and beyond. The Patient Protection and Affordable Care Act (PPACA) mandated $200 Billion in cuts to the MA program. In addition, the 2012 Fiscal Cliff deal cut $2.5 Billion from Medicare Advantage through a coding intensity provision. The Congressional Budget Office has outlined projected cuts to these programs in the coming years:

Even though only a small portion of PPACA cuts have taken effect so far (only ten percent of the cuts will have gone into effect by the end of 2013), the reduction in beneficiary choices has begun.[iv]  The number of MA plans is projected to drop in 2014.[v] Although we understand that Congress faces many difficult choices in the budget debate, we are concerned that any further cuts to the MA program will undermine the ability of the program to sustain its impressive track record in improving care and reducing costs for Medicare beneficiaries.

We would be pleased to provide additional information on the program, highlight examples of the program’s success, and further detail the positive impact it is having on the lives of America’s seniors.  If we can be of assistance, please feel free to contact Vicki Shepard at 202-525-9588



Fred Goldstein

Acting Executive Director

Care Continuum Alliance

Vicki Shepard

Chair, Government Affairs Committee

Care Continuum Alliance

[i] “Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients.” Health Affairs 31.1 (2012).

[ii] Lemieux, J., Sennett, C., Wang, R., et al., “Hospital Readmission Rates in Medicare Advantage Plans.” American Journal of Managed Care 18(2):96-104 (2012).

[iii] Centers for Medicare and Medicaid Services, Medicare Advantage, Hill Notification Document, 11 (2007).

[iv] Congressional Budget Office, Letter to the Honorable Nancy Pelosi (March 20, 2010).

[v]Avalere Health analysis of CMS Landscape File, September 23, 2013 accessed at


%d bloggers like this: