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 Vicki.shepard@healthways.gov.

Sincerely,

/signed/

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 http://www.avalerehealth.net

 

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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. HealthCare.gov 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.

Incentive-Based Wellness Initiatives for All: Good practices = Good Outcomes

CCA has long supported the use of incentive-based workplace wellness programs. We’ve issued recommendations on core components and the role of incentives, and certainly agree that programs should not “inappropriately punish workers in poor health, [be] overly coercive, or create perverse financial incentives that result in poorer health outcomes.” We further believe that existing federal and state safeguards should be applied to programs that violate existing HIPAA requirements for reasonable design, annual requalification, alternative standards and other benchmarks. In short, there’s a growing body of research that clearly demonstrates the value of wellness programs, including those employing incentives for participation and outcomes, for improving health and reducing preventable health care costs (see here, here, here and here).

Congress, too, recognizes the value of wellness programs for all populations. The Affordable Care Act provided landmark recognition of workplace and community-based wellness and prevention programs. Particularly important, the statute in 2014 will increase from 20 percent to 30 percent of total premiums the allowable value of incentives employers may offer employees to participate in workplace wellness programs. We applaud Sen. Tom Harkin, D-Iowa, for his continued support for workplace wellness initiatives.

Now, another leading Senate Democrat is poised this week to unveil legislation that would offer incentive-based wellness programs to Medicare beneficiaries. This legislation recognizes the importance of wellness initiatives, including smoking cessation and weight management, and the success of incentive-driven wellness initiatives for our nation’s seniors.

I’m delighted to report on these developments and the sustained march toward greater awareness of the value of wellness programs for all populations. These developments stand in direct contrast to the thinly veiled conjecture and anecdotes propagated by policy organizations and advocacy groups that repeatedly ignore the preponderance of evidence on the benefits of workplace wellness programs.

Clearly, there is significant evidence of the positive impact of incentive-based wellness. CCA looks forward to supporting this important new Senate legislation and to promoting the real truth about wellness programs, using evidence and research rather than speculation and fear tactics.

—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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