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

Prevention is Not Expendable

A core component of the Affordable Care Act is the most comprehensive recognition to date of the value of prevention and health promotion. Numerous provisions in the ACA support wellness and prevention efforts in the workplace and in Medicare and Medicaid. CCA has repeatedly applauded these provisions and actively and aggressively supports their rapid implementation.

Yet, we continually face efforts by Congress and even the administration to target the ACA’s landmark Prevention and Public Health Fund as an extraneous cost – particularly now, in discussions on the fiscal 2013 federal budget. But the Prevention Fund is anything but extraneous or expendable. Rather, it provides a critical catalyst for the surge nationally in health care system innovation and care delivery improvements.

CCA strongly supports allocating monies dedicated to the Prevention Fund to fulfill its intended purpose and to power health care transformation. The Department of Health and Human Services must seize the opportunities made possible by the Prevention Fund through community collaborations and partnerships with health care industry leaders. Congress, rather than looking to the fund for easy cuts, should instead encourage its constructive use legislatively, such as through Sen. Ron Wyden’s “Medicare Better Health Rewards Program,” which would apply Prevention Fund monies toward initiatives that build on programs already established through reform.

States have a stake in the Prevention Fund’s viability, as well. The Fund materially impacts and advances individual state health care initiatives, such as behavioral health screenings, data infrastructures and wellness services. It has contributed more than $121 million toward state projects in Ohio, California, Nevada and Kentucky alone. provides a full public accounting of individual state contributions and program descriptions.

The Prevention Fund already has sustained a 10-year, 33 percent cut through February’s Middle Class Tax Relief and Jobs Creation Act. Additional cuts would derail federal and state progress toward prevention and health promotion, stifle health care transformation and undermine significant industry investments in innovation.

Stakeholders are working continuously and at an unprecedented pace to drive the health system toward better care, better health and lower costs. The Prevention Fund must remain available to achieve this important goal.

IOM Report Reflects Expanding Role of Population Health Management

Over the past couple weeks, there’s certainly been no shortage of commentary on our industry and its evolution from the early days of siloed, call center-based disease management to today’s integrated, sophisticated population health management (PHM).

Certainly, the recent CBO report was a catalyst for some of these conversations—especially as the Care Continuum Alliance (CCA) and others highlighted the outdated design of the programs detailed in that report. But another catalyst is the increasing interest in PHM strategies from public and community health organizations, as well as primary care groups.

This was reinforced in my mind this week as I read the Institute of Medicine (IOM) report, Living Well with Chronic Illness: A Call for Public Health Action. At the request of the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation, the IOM developed the report to identify public health strategies that reduce disability and improve the function of and quality of life for people with chronic conditions.

As you’d expect, the report focuses on public health and its authors almost exclusively are public health leaders. The important point here, however, is that the report gives great attention to and identifies significant opportunities for the current and likely future iterations of population health management strategies and services. Specifically, the report includes several recommendations significantly relevant to our industry, including that:

  • the CDC increase demonstration programs for chronic disease control that cut across specific diseases or multiple chronic conditions and emphasize mitigating the secondary consequences of various chronic conditions;
  • the Department of Health and Human Services and state and local government public health agencies evaluate existing, emerging and new models of chronic disease care that promote cooperation among community-based organizations, the health care delivery system, employers and other stakeholders to support living well with chronic illness; and
  • HHS supports states in developing comprehensive, collaborative, population-based strategic plans with resources that focus on the management of chronic illness, including community-based efforts.

A key takeaway from the IOM report: Ultimately, successful health care is local. Current federal and state policy priorities seek to advance this concept through community-based, primary-care led models to improve health and health care quality and to constrain costs. Yet, all stakeholders recognize that this evolution in health care delivery will require the integration and coordination of numerous care providers and services in new ways. We’re seeing this happen throughout the industry in multiple collaborative projects. The IOM cites other challenges, including a lack of incentives for care coordination and the prevalence of fee-for-service payments.

This week’s IOM report asserts the potential for community-based care and collaborative models to improve the lives of people managing chronic conditions and to mitigate the impact of chronic disease. These models will benefit from the very strategies and tools in the wheelhouse of population health management as practiced today. It’s a particularly salient point in a week when so many were overly fixated on old approaches to chronic condition care.

—Tracey Moorhead, President & CEO

Health Care Policy Perspective and Insights

Care Continuum Alliance began hosting policy briefings for its Board of Directors three years ago, with a day we called the “Capitol Caucus.” The day has been a great opportunity for our industry leaders to step outside of their day-to-day corporate areas of expertise and hear the latest on key policy issues influencing the growth and evolution of population health management. Our Board members have commented on the high value of these briefings, with one Board member telling me, “This is the most productive day I’ve ever spent in Washington, D.C.”

Well, CCA staff and Board members want to share this valuable experience with a broader swath of our members and industry leadership. This year, for the first time, we’re opening Capitol Caucus to a small group of non-Board member attendees. Capitol Caucus 2012 is shaping up to be a fabulous opportunity to hear updates and insights on a broad variety of health care policy issues, including Affordable Care Act implementation. Attendees also will hear an election-year forecast from a highly regarded campaign analyst.

We’re working hard to confirm speakers on an invitation list that includes Congress, the Centers for Medicare and Medicaid Services, Office of the National Coordinator for Health Information Technology, the Medicare Payment Advisory Commission, the National Governors Association and other federal and state offices; you can view the tentative agenda here, as well as member and non-member registration pricing and sponsorship opportunities.

This event aligns strongly with our strategic vision for advocacy, education and research: to convene, educate and communicate on behalf of population health management and to promote PHM strategies and tools to improve the quality and value of health care. I hope you’ll be a part of that process by joining us at the Capitol Caucus.

—Tracey Moorhead, President & CEO

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