“Why health reform will succeed” — Politico, by Sen. Tom Harkin (September 29, 2009)

“In Delivering Care, More Isn’t Always Better, Experts Say” — Washington Post, by Ceci Connolly (September 29, 2009)

“Latest Lie: ‘Death Panels By Proxy’” – TIME, by Karen Tumulty (September 27, 2009)

“Health reform should include efforts to fight obesity, group says” — American Medical News, by Susan J. Landers (September 24, 2009)

At the PFCD’s third quarterly advisory board meeting, which was held earlier this week, we discussed the prevention, disease management and care coordination provisions in the current bills (Senate HELP, Senate Finance and House Tri-Committee).
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One point I’d like to share from that discussion was the notion that the current legislation as it is evolving is taking an “a la carte ” approach, with some functions like transitional care provided as a stand-alone benefit, and others such as community health teams and other forms of medical homes that include all these functions combined and fully integrated are provided only as pilots.
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We know from published research literature that prevention and care coordination that includes transitional care (coordinating care as patients enter and leave hospitals, nursing homes), coaching and education, the ability to refer to community-based primary prevention programs, and close integration of care coordinators with primary care practices has been successful at improving health outcomes and reducing short-term and long-term costs.
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However, the “a la carte” approach to building effective primary prevention capacity and care coordination runs a substantial risk that these programs, when implemented independent of one another, may or may not work together as effectively as they would when all the key functions were designed as part of a single program (like CHTs, medical homes, etc).
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I commend Congress for having these provisions in the bills in the first place—it is an excellent start toward incorporating preventive care into our delivery system. As Congress moves through mark-up of the bills and begins to pull together the final legislation, however, they would do well to look at these provisions and make sure they are fully integrated and comprehensive, because that is how we will see the biggest impact on our health and health dollars.

“We need to return to the basics for health reform” — Atlanta Journal Constitution, by Kenneth Thorpe (September 23, 2009)

“Cost Savings Adds to Value of Preventing Chronic Disease” — US News & World Report (September 23, 2009)

“Health-care markup is just beginning” – Politico, by Carrie Budoff Brown (September 23, 2009)

“Baucus Pushing to Send Health Bill to Senate Floor by Week’s End” – Congressional Quarterly, by Alex Wayne (September 22, 2009)

“Key Senator Says He Will Alter Health Proposal” — New York Times, by Robert Pear and David Herszenhorn (September 21, 2009)

“Report Rounds Up Proven Prevention Programs” – Congressional Quarterly (September 21, 2009)

“Baucus Will Tinker With Health Bill to Mollify Critics” — Wall Street Journal, by Greg Hitt (September 18, 2009)

“Attacks on Baucus health bill signal intact reform effort” — Washington Post, by Ceci Connolly (September 17, 2009)

Yesterday, Chairman Max Baucus unveiled the highly anticipated Senate Finance Committee health care reform proposal, “America’s Healthy Future Act of 2009.” While some groups have voiced disapproval, many believe that it was worth the wait. 

Personally, I believe the release of Baucus’s Mark steers us in the right direction along the road to reform by including changes that will help to stem the steep rise in health care costs.  In particular, I’m encouraged by several provisions that place great emphasis on promoting chronic disease prevention and wellness. These will help ensure real change in the health of all Americans and the U.S. economy.

These include:

• Enhancing Medicare Coverage:  Since almost three out of four Medicare beneficiaries has multiple chronic illnesses, the bill’s biennial wellness visit is a welcome addition to the Medicare program. 

• Reducing Patient Financial Barriers to Health Improvement:  By providing incentives for making healthy choices and removing cost-sharing for recommended preventive services the bill aims to motivate Americans to follow-through on treatment and utilize preventive care.  

• Improving Care Coordination:  The bill creates programs to manage care transitions, expand medical home options to Medicaid patients with chronic conditions, and develop standards that promote improvements in health outcomes for patients.  The bill also calls for a move toward bundled payments and encourages the development of Accountable Care Organizations (ACOs).

• Strengthening the Quality of Care:  Policies that link payments to the quality of care could help improve health outcomes and implementing a national quality strategy would provide national leadership to set goals and meet quality benchmarks. 

Furthermore, Baucus encourages development of new models of patient-centered care by proposing an Innovation Center in Medicare.  This Center would fund expansion of key delivery system reform programs such as community health teams, which help smaller medical homes better manage and prevent complications from chronic disease.  They are particularly important since 83 percent of primary care practices have fewer than 3 physicians.

Not only is this proposal the most comprehensive we’ve seen so far, but it is also one of the least expensive options currently on the table.  The CBO scored it at $774 billion over 10 years - $100 billion less than the House bill.  Since cost is of critical concern in the health reform debate, this is great news for efforts to ensure passage of meaningful, sustainable health care legislation this year.

“The Senate Is Ready to Act on Health Care” — Wall Street Journal, by Max Baucus (September 16, 2009)

“Baucus Introduces $856 Billion Health Care Bill” — Washington Post, by William Branigin and Lori Montgomery (September 16, 2009)