tv Hearing Examines Health Care for People with Chronic Illnesses CSPAN May 16, 2017 10:03am-11:48am EDT
sen. hatch: meeting will come to order. i would like to welcome everyone to this morning's meeting on bipartisan policies to care for patients with chronic conditions. years almost exactly 2 ago today we reformed a bipartisan working group cochaired by senators isakson and warner to work on legislation to address these issues. that working group spent many months listening to stakeholders in the health care community, both in person and through more
formally submitted comments. in december 2015, the working group released a comprehensive policy options document. in october of last year we issued a legislative discussion draft. 4on after that, cms finalized of our policy proposals in its 20 17th medicare schedule role, and 2 positions from our discussion draft were included in the 21st century cures act, which president obama signed into law this past december. in other words, several of the working group's policies have already been enacted, and we are working to get the rest signed into law and fully implemented. introducet end can we the latest version of the chronic care act, a bill that encompasses the working groups proposals, in april. the legislation currently has 17 bipartisan cosponsors and has
been endorsed by numerous organizations in the health care community. today is the latest step in our efforts. the next step will come later this week. we have noticed a markup for thursday morning. i want to thank my colleagues, ranking member sen. wyden, for his work on this matter. his passion for improving care for those with chronic conditions has been a driving force behind this effort. of course, i want to thank senators isakson and warner, who worked tirelessly to lead our working group. through their efforts, the committee has not only learned about the burden imposed on medicare patients living with chronic conditions, but identified new policies to improve care coronation, increase value, and lower costs in the medicare program without adding to the deficit. today's hearing will provide us
with an opportunity to examine these policies more expensively so we can better understand how they will help patients and enable providers to improve care and produce better outcomes. of bill includes a number policies that would improve care for the chronically ill through increased use of telehealth by giving medicare advantage plans to certain accountable care organizations, enhanced flexibility to services to medicare patients with chronic conditions. senators schatz and wicker have been instruments in this particular effort, and i'm pleased to have them here with us to talk about how the chronic care act advances their policy goals. i would be remiss if i did not also recognize the finance committee members who have joined senators schatz and efforts toker's promote increased use of telehealth services. in that regard, we appreciate the leadership of senators thu
ne, cardin, and warner on these matters. while many stakeholders offer key advice on telehealth policy, i want to thank the fine institutions in utah, "telestroke" on the policy. , the doctors of the university of utah as well as the doctor within about health care. i appreciate your willingness to share their experience and expertise on technology to properly diagnose individuals presenting stroke symptoms. i look forward to hearing more on this particular aspect of telehealth here today. but first, our bill goes beyond telehealth making improvements to beneficiaries who receive care across the medicare spectrum including fee-for-service, accountable care organizations, and medicare advantage.
we have a panel of recognized experts before us today to discuss all of these issues, and i want to welcome each of our distinguished witnesses. obviously, i'm well aware that there are some contentious debates going on in the health , and therethese days is no shortage of political and partisan points that people would like to make in a venue like this. however, for today's hearing, i sincerely hope we can maintain the bipartisan spirit that has driven our efforts on chronic care act. end, i respectfully ask members of the committee to focus their questions on the policy areas specifically addressed in the bill. ith that, i'm going to turn over to sen. wyden for any opening remarks he would like to make. sen. wyden: thank you very much, mr. chairman. i want to thank you, mr. chairman, your staff, senator warner, senator isakson. this is an extraordinary
hearing, and i will touch on why. but it could not have happened if you would not have been willing to initiate a committee like process. process couldide again, i want to thank you for all the efforts to make this morning possible. colleagues, i looked forward to today for many years. that is because the finance committee is now beginning to ofkle the premier challenge american health policy, specifically, by updating the guarantee of medicare to better serve seniors with chronic illness. when i was codirector of the argonne gray panthers, medicare had just 2 parts a and b. ankle and hadour surgery in the hospital, you were covered by part a. if you got a really bad case of the flu and you went to the
doctor, you were treated by the doctor in their office, and that was part b. that is not medicare today. today, medicare is cancer, it is diabetes, it is heart disease, it is strokes, and it is other chronic conditions. seniors who have or more of these chronic conditions2 now account for more than 90% of all medicare spending. and today, older people get their care in a variety of different ways. there is still fee-for-service, and there is also medicare advantage, accountable care organizations, and a host of innovations being tested across the country. guarantee,icare is a a promise of defined benefits,
it is past time to update this tomise so as to deliver patients with chronic conditions the best possible care in the most efficient manner. on,s the chairman touched the legislation today begins this transformation. older people will get more care at home. less in institutions. there will be expanded use of life-saving technology. that is why it is so good to see senator schatz and senator wicker here to talk specifics. there will be a stronger focus on primary care and expanded use of nonphysician providers. , still to come is ensuring that each senior with multiple chronic conditions has an advocate to guide them through what can be a teeth
of trying torience navigate american health care. 2 final points, one picking up on the debate about the affordable care act. i would just say, colleagues, this is the way to do it right. doors were opened here, not closed. there was bipartisan cooperation , not partisan reconciliation. the public was asked to shave the bill, not take it for granted. and finally, i want to thank our partners. chairman hatch and i have senator warner and senator isakson coordinating this effort. the chairman made a mention of the fact that many colleagues both on and off the finance committee have really helped to produce what our witnesses are going to call this morning a model for how to take on tough
challenges. it has been an honor for me to be part of this bipartisan .ffort on and off the committee like you, mr. chairman, i'm pleased that our colleagues senator schatz and senator wicker are with us today. sen. hatch: we are pleased to welcome senator roger wicker and brian schatz to our hearing today. as i mentioned in my opening statement, these two senators have done a lot of work on telemedicine and telehealth issues. we appreciate your support and input today, and we look forward to hearing your thoughts on these important issues, and your perspectives on this important topic. sen. wicker: provide his statement first, and then be followed by senator schatz -- senator worker will provide his statement first and then be followed by senator schatz. please proceed with your remarks and then we will take senator schatz next. sen. wicker: thank you, mr. chairman.
thank you, ranking member wyden, and my distinct colleagues. thank you for allowing me to share what we already know in my home state of mississippi, telehealth works. to discuss be here the promise of telehealth and celebratory breath your committee -- celebrate the progress your committees making with the act, which i have enthusiastically cosponsored. i would like to commend the leadership of the senate finance committee for their years of work to address the cost and quality of chronic care in america. today is a testimony to your efforts. i am pleased to be here today with my friend senator brian schatz. he and i are on the commerce subcommittee on communications, technology, innovation, and the internet. committee, wee have worked tirelessly to promote innovation by removing barriers to connectivity and expanding access to rural broadband. it was during a 2015 hearing of our subcommittee on the potential of telemedicine when
senator schatz and i decided to join forces to reform how .edicare reimburses telehealth we were fortunate to form a team including senators warner, cochrane, and the result was the connect for health act, a widely supported legislative proposal for telehealth. 16, ist for health, s. 10 the product of hard work and determination. it is designed to improve the quality of care and cut costs. i thank the committee for improving telehealth provisions inspired by our connect bill in the bill we are discussing today. in so doing, you are recognizing the promise of telehealth. i became interested in this topic because my home state of theissippi has led nation in maximizing technology to improve patients' .
the university of mississippi medical center in jackson has been a leader in telehealth for over a decade. the team has managed to increase access to quality care and cut costs by using services like remote patient monitoring and tell emergency, reaching some of ,ur state's most rural vulnerable, and costly patients. mississippi is a very rural state, and we have some of the toughest health problems, too. we have the fewest providers per capita, and the highest rates of heart disease and type two diabetes. these health disparities and barriers to access are what drove the university of mississippi medical center to experiment and innovative with telehealth. one of the many mississippi telehealth success stories is the diabetes telehealth network, a remote patient monitoring program that provides verbal mississippi patients who have
uncontrolled diabetes with routine access to a provider through a medical tablet. this partnership began following 200 chronically ill patients in the underserved mississippi delta. the technology allowed providers to monitor and care for the patients remotely on a daily basis, following their vital signs and intervening when things didn't look good. throughout the course of the of the 100 zero patients were admitted to the hospital. think about that. no emergency room visits for any of these previously chronically ill patients. this is an excellent care that can improve patients' lives. in fact, telehealth can save money also. the mississippi department of medicaid found that if this remote monitoring program were extended to just 20% of
mississippi's diabetic medicaid population, the state would save $189 million per year. medicaid, like medicaid programs in virtually every state, is expanding access to an coverage for telehealth and remote patient monitoring. however, medicare is behind the curve, limiting access for millions of seniors. imagine the incredible act this technology could have if medicare would allow its most vulnerable beneficiaries to use something like remote patient monitoring. i'm confident that the success we have seen in mississippi can be replicated for patients across the united states upon enactment of the chronic care act and, ultimately, enactment of connect for health. we are still looking for cosponsors, mr. chairman, and we
will not stop until access to quality care through telehealth is realized for medicare patients. the chronic care act is a step in the right direction. we have more work to do in this space. and i look forward to continuing to work with each of you. thank you, sir. sen. hatch: thank you. i think i'm a cosponsor. if i'm not, put me down. senator schatz, we will take you know, and then we will turn to sen. warner, was played a significant role in this. sen. schatz: thank you, chairman hatch, ranking member wyden, distinguished colleagues and members of the senate finance committee, for holding this important hearing on bipartisan legislation. i'm happy to cosponsor the chronic care act, a bill that can help improve outcomes and disease management for people on medicare who have chronic illnesses. right now, progress in modern technology has not translated into progress across the health care system.
that impedes the health system's ability to provide high-quality care, improve access to care, and to lower costs. and so it is time to bring medicare into the 21st century by taking full advantage of telehealth and remote patient monitoring. when we are talking about telehealth, we are talking about using technology to provide clinical services to patients remotely. telehealth more broadly can include nonclinical services like provider training. one type of telehealth relies on live video, audio or visual technology. it is like using a secure cetime sof skype or fa that a patient can connect with his or her health care provider. when these substitute for traditional in-person visit, they can save your expenses, they say-- save er expenses, they save travel time. they use store technology, another type of telehealth which is exactly what it sounds like.
providers can take an image like the next way or other clinical picture, storage, and then send it to a specialist anywhere on the planet. there is also remote patient monitoring. if i high-risk patient with a chronic disease needs to have her blood pressure or blood sugar monitored, she can use the device at home to collect and send the data to a provider remotely and continuously. this improve the outcomes for the patients with chronic conditions and saves money, too. the veterans administration, the department of defense, and the private sector are all taking advantage of telehealth and remote patient monitoring and approving access to care, improving quality of care, and saving money. the problem is that medicare is not. it is limited by an old law, of the social security act, which puts restrictions on the use of telehealth. the law says that patients must
be located in certain originating sites in order to use telehealth. they cannot be seen at home. they can only be located in certain rural areas. only certain types of physicians and practitioners can use telehealth under medical or good physical therapists or occupational therapist cannot. remote patient monitoring is hardly covered at all. that is why senator wicker and i come along with senators warner, and 13 other members of the senate and almost three dozen members of the house -- and everybody is invited -- have cosponsored the connect for health act over the past two years. our built would lift medicare restrictions on these of telehealth and improve coverage of her motivation monitoring. i know the chronic care working group has worked in a similar bipartisan fashion to build consensus and find ways to advance legislation. there are 4 provisions in the chronic care act and the connect for health act that would help
patients lower costs. 1834minclude lifting restrictions that hold back patients who have had acute strokes or need home dialysis, people enrolled in medicare accountable care organizations. while these provisions are an important first step, we still have further to go. we look forward to working with this committee to continue to advance the important provisions in the connect for health act, including improving coverage of remote patient monitoring, lifting 1834m restrictions, including global and bundled payments, and giving the secretary of health and human services more flexibility to waive these restrictions as certain costs and quality metrics are met. thank you to chairman hatch, ranking number wyden, senators warner and isakson, and all the members of the finance committee for the privilege of speaking before you today, especially thank you to my partner on this legislation, senator wicker. sen. hatch: well, thank you both
very much. we are very appreciative that you appeared before the committee and gave your excellent remarks. we turn to sen. warner for whatever he would like to say. sen. schatz: thank you -- sen. warner: thank you, mr. chairman. i think it is particularly great to see that you both more purple ties today. gives aor coordination little extra -- >> so did the chairman. sen. warner: so determined that it shows when there is a will, there is a way. [laughter] sen. warner: this chronic care topic is obviously extraordinarily critical, and i want to thank the chairman and ranking member resting sen. isakson and i -- for asking sen. isakson and i to work on this group with you. sen. isakson isn't here him about as with so many projects he has been a great partner. i thank you and sen. wyden.
i echo what senator schatz and senator lugar said in terms of telehealth being -- senator wicker said in terms of telehealth being a critical part of chronic care. the truth is, as a population ages and americans survive acute illnesses to an extent previously unimaginable, we need to make meaningful reforms to our health programs so we can move medicare into the 21st century, to ensure high-quality care. although the rate of increase in the national health spending may is slowing, our aging population and the uncertainty around the ourrdable care act means public health systems will continue to face serious financial challenges. i know this area as than a particular topic for sen. wyden for some time and he has repeatedly pointed out the fact that an individual has more than six illnesses in terms of chronic disease. that is only 14% of the medicare correlation, that accounts for half of the medicare spending, and as people today, those
numbers are only going to go up -- people continue to age, those numbers are only going to go up. wekling systemic reform, how pay for quality, how we measure value, are key challenges in what we need to get right. this chronic care working group, which we have been part of and working with colleagues like senator wicker and senator schatz, i think we have got a good product, and i think the chairman and wrecking member. hopefully we will move on this evening if we cannot agree on other areas in the health care field. our current system fails to adequately care for patients with chronic conditions. unfortunately, while our health-care system does a great job of paying for individual procedures -- surgery, chemotherapy, hip replacements, etc. -- it does not provide a good job of paying health care providers to coordinate care and to treat patients in a way that takes into account how these progressing conditions really do
affect the lives of patients and their families. ,his product care working group received 530 comments by the health care community, and subsequently, our staff met with 80 individual stakeholder groups. we put together a series of proposals that, i believe, would modernize the health care system. they would expand the telehealth services available to home dialysis patients. i have a daughter with diabetes. i know how important it is to get that monitoring done at home. provide greater availability of telehealth services to individuals with stroke symptoms. some of the telehealth components of your legislation. improve the design of medicare ,dvantage to provide targeted high value services for individuals who need it the most. another provision of what we are proposing would provide better care planning services provided on the directing gao to submit a
report to congress to promote the development of a payment code for comprehensive care planning. this is an issue i had working on since my tenure in the senate, goes back to my time as governor. my mom had alzheimer's for 10 years, did not speak for nine of those 10 years. trying to get that right and make sure we no longer have the distinction of being the only industrial nation in the world that has not had a national conversation about that part of life. it's something that i think we take a step in his chronic care working group to getting done. perfect, these initiatives moves medicare systems for better coordination, better quality, better cost-effectiveness, and except towards moving medicare in the 21st century. on behalf ofnk senator isakson both the chairman and ranking member for helping us for on this. sen. hatch: thank you. we appreciate all the work and we appreciate both of you at this table.
opportunity tohe hear from 4 other witnesses that will inform our path forward on chronic care. i want to welcome these 4 witnesses and thank them for their willingness to testify today. we will first hear from katherine hayes, the director of health policy at the bipartisan policy center. pc, ms. hayesing b was an associate research professor at george washington university school of public health and health services. prior to joining gw, ms. hayes served as vice president of health policy for jennings inc., andategies, worked as a health policy advisor for 2 large catholic health systems. the children's hospital. ms. hayes also served as the health policy advisor to members of the senate and house of bothsentatives in
political parties. she served as a program consultant to the state of missouri, medicaid agency, and helped the education policy advisor in the state of texas in the office of state-federal relations. ms. hayes received a bachelor of arts degree in international studies from the university of north carolina at chapel hill, and a juris doctorate from the american university washington college of law. following her remarks, we would ,ear from dr. lee schwamm professor of neurology at harvard medical school, and executive vice chairman of neurology at the massachusetts general hospital, where he is the chief of the stroke division . he serves as the director of the partners national telestroke network, as well as medical director for mgh telehealth, and as cochair of the innovation counsel partners health care. he has authored over 250 peer-reviewed articles, and is
chaired or cochaired many of the current practice guidelines for stroke and telehealth enabled care delivery. graduated from harvard medical school in 19 91 and completed his neurologic training and fellowship in a narrow critical care and urology at the massachusetts general hospital. he is testifying here today on behalf of the american heart association and the american stroke association. third, we would hear testimony from john loveless, -- john g lovelace, the president of upmc for you, which serves medicare advantage ecial ed pn repitsn cnts. ao rv apridt gornntroaman invialdvta f t up iurceerce disis,s ll athchf ogm oicn haor
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so many bad things flow from people being overweight. i was in dover, delaware, and i went into one of the rooms. they had a hoist. i said what is this for? it is for people overweight. i said, how heavy? 700, 800 pounds. unbelievable stuff. in terms of getting on the right track to a better job of , give me this trend one piece of advice for what we should be doing here at this level to help win this war? dr. rosenthal, mr. rosenthal? stephen rosenthal: it begins at a very young age. adolescents, obesity begins the whole sequence that brings individuals to complicated illnesses that obesity can lead
to. it begins in the school, school health systems. we are very active in the school health. we have one of the largest networks of school-based health care, educating our young children today on eating habits, exercise. if we can begin at early ages, we begin to stem the tide on obesity. sen. carper: thanks. mr. lovelace. john lovelace: i would agree with that. emotionally there is. we don't know -- we know we should not smoke, should not eat cheeseburgers for breakfast, but people do it anyway. early, healthyng , a lifexercises expectation, not something to change yourself to do when you are an adult. sen. carper: thank you. lee schwamm: very important contributor to stroke, and they are on the rise in young
americans shockingly and depressingly. avoiding the sedentary lifestyle is critical and making affordable healthy food choices available routinely. one diet soda a day triples your risk of stroke in dementia. we are what we eat, and we need to be focused on healthy food. sen. carper: thank you. katherine hayes: i think education on what to eat and the importance of physical activity is absolutely important, but there are confusing messages in marketing. my mother has heart disease and diabetes and has been struggling to keep her sugar levels low. because she cannot go upstairs and use the kitchen in the home, she would find prepackaged meals that are convenient, and there is so much salt, she ended up in the hospital because she had too much sodium and started having health problems again. i would agree making healthier
fillable -- foods available. sen. carper: my time is up. thank you, mr. chairman. i want to thank you and mr. wyden for holding this. i am pleased with the progress we have made for the bipartisan product care act, and i look forward to working with you and the members of this committee on ways to further promote coordination so we can improve outcomes for medicare beneficiaries. i want to recognize senators for the healths working group for teaming up to increase access to new technologies. the inclusion of a number of connect for health provisions in the chronic act is improving beneficiary access to timely and effective health care. dr. schwamm, thank you for being here today. earlier this year i introduced the furthering access to telemedicine or fast act.
, south parts of it dakota fell into a professional health shortage area, and you mentioned in your testimony that even some urban and suburban regions that don't have access to -- could you talk about how geographic and originating site restrictions on telehealth technology have limited access to the time sensitive statements for stroke victims in rural and urban areas? lee schwamm: it would surprise people to know that 90% of the strokes every year are occurring outside that coverage area, so the area that medicare has designated coverage for is a relatively small geographic swath of the united states and not densely populated. the places that need this treatment are not far from where you and i live.
when i started doing this work 15 years ago, hospitals 15 or 20 miles away from mass general were not treating with cpa because they did not have the ability of a stroke expert. it is very straightforward to provide necessary information you need at the bedside to make it diagnosis of stroke, review the patient, talk to the family, make a decision with the bedside physician with the technology we have available today. the main barrier now is creating an environment where people feel there is no option. this is a standard of care, and every hospital needs to be able to provide this basic evaluation. we would not accept the idea you can come into a hospital with a heart attack and told, i don't have a heart expert available, we will send you to another hospital an hour away. when you arrive, it is too late. we have to have that same attitude towards stroke and
opening up the geographic restriction will encourage many more hospitals to initiate. in your testimony you mentioned the savings in telehealth technologies instead of treating the lasting effects of stroke after the episode occurs. what are some of the issues faced by stroke survivors that did not receive timely care as those that did. there are huge, hidden costs of stroke on our society. patients become disabled, often can't return to live at home, or they need close to 24 hours care. loved ones, children have to give up working or reduce their work to be able to make .vailable
if people need care, they go through their savings first and go into a nursing home with readmission for bedsores, pneumonia, urine infections, current stroke. it is a very debilitating disease. her life changes in instead. changes in an instant. we know tell a stroke -- we know it saves money because it avoids long-term disability and a substantial portions who receive it. in the late 1990's, $4000 per treated patient of savings because of the reduced burden. if you multiply that together with 500,000 medicare beneficiaries available for consultation with restrictions removed, you see savings will accrue. whether they do to medicare budgets, state budgets or other payers, someone smarter than me
will have to figure that out. but it is the right thing to do to find a low-cost way that is effective. we encourage hospitals to do it anyway if they have a stroke expert on hand. the cost is trivial. we are talking about spending more money to reduce long-term disability which is the highest level of evidence recommendation of every major professional. sen. thune: i just mentioned, i want to associate myself -- i understand senator stamp already talked about values-based like --e is, so i would she has covered that. sen. hatch: thank you. senator cartman. cartman: thank you. i want to thank you and senator wyden for bringing this forward. it is a bipartisan basis, and i think it will lead to some good
results as legislation. i want to follow-up with senator thune's point. i see the first part of my state, oklahoma city, very rural , where they don't have the type of specialists you would have in most communities. ophthalmology is performed through telemedicine. it is working well. dealing with the stroke victims, we have three programs in maryland working today, one in carroll county, westminster. one in maryland but is working well. .e have a program in hagerstown it is also working well in conjunction with a major center. so we have programs in our state that are performing extremely well. also incorporated is the
dialysis patients. victim, the cost savings by reducing the disability and time intervention is critically important. for a dialysis patient, it is a matter of cost getting to a center, trying to have some degree of normalcy of life. tele-exam to do your so a person can get care at home exit better. -- makes it better. so this bill moves us forward in telehealth, but where do you see telehealth going? what obstacles are in the way? what concerns do we have as we move towards telehealth system so people can get more timely and efficient care? dr. schwamm if you want to start
, then others. i'm curious on what we need to change to accommodate this type of health care. lee schwamm: it is one of my favorite topics, so thank you. on dialysis, anything to improve convenience and access will increase the delivered to the -- delivery of those services. we spend a lot of money on ambulance transport. that is another hidden cost effective because radically reduced by using telehealth in these circumstances. my hope and vision is 10 years, to 15 years from now, we won't call it telehealth. it will just be health care. there is no reason why this artificial dichotomy, person versus virtual, will persist. we don't call it mobile banking and think about it as a different enterprise and have separate cost and decide you can't do certain transactions.
anything you can do that way saves money. makes it more convenient, more desirable. i think we have to examine the health care encounter. there is more than one type, the construct individual parts, and reassemble them in a way that is patient-centered, not doctor or hospital-centered we could provide better care sooner and intervene up stream before problems manifest. we have to fund research before what we decide to do is evidence-based and not just the flavor of the day, what is attractive to consumers. .t must be driven in this way we are developing evidence and testing hypotheses. we also don't want to create a new digital divide where we can have a new class of vulnerable people because they don't have access to this technology. these are very important parts of weaving telehealth into health care.
sen. cardin: you heard earlier the healthr wyden, care system is designed for health care providers, not users. customization of health to make services more accessible, convenient, timely is an improvement towards a more consumer-friendly model that would give people the better ability to manage their health with improved access to quality standards. and telehealth has the ability to allow for monitoring of consistency rather than what happens behind the door. >> and in the reimbursement structures, there is moving towards family friendly technology. >> restrictions on the state legislature and billing and whether the physician is licensed in the location with the patient would make a lot
more sense to be licensed where they are rendering care, rather than where the patient is located. it is crazy when they lives in new hampshire, sees me in boston when they are in crisis, and needs my help, that i technically shouldn't provide medical advice when they call from their home in new hampshire. there is a lot of opportunity to rethink what it means to be licensed to practice medicine over telephone. sen. cardin: thank you, mr. chairman. add to whatng to dr. schwamm said. technology is evolving so quickly that it will become a component of our everyday life. making sure we understand the on theof those tools health outcomes becomes important. so the opportunities are enormous, and i appreciate the vision. sen. hatch: senator bennett's. bennett -- senator
for holding this important hearing and for your leadership. i want to thank senators eisen and warner for convening the group. a lot of good work has been done , and it makes the solutions on how to improve, are coming to the for now. u.s. areses in the linked to the care of more than one chronic condition. diabetes parkinson's, heart disease, these are loved ones making multiple doctor visits, complicated instructions, may need a caregiver to deal with daily tasks. independence the home act would improve patients getting care from the comfort of their own home but also reduce cost. i would like to thank the senators for their leadership,
aking the home demonstration permanent program. it makes it possible for different health care professionals to provide access day, sevenhours a days a week, insuring multiple chronic conditions. the home payment model saved around $3000 per participating beneficiary. seeing the expansion of the act included in the chronic care act , if we go further to make this national, programs like upmc in , theye state of colorado conserve even more chronically ill patients with better cost-effective care. john lovelace: absolutely. we are fans of the home independently model. we have a version not quite the same as the other one about -- multiple managers, social workers. people to havee
eyes on, consistently managing, rather than waiting to get to the emergency room. sen. bennet: have you been able to measure cost savings in your own operations? john lovelace: we don't do it as it is laid out in the bill, but it does reduce a significant reduction in health care plan care. money on the whole total of -- it saves unplanned money. it is a breakeven for us at this point. sen. bennet: dr. schwamm. lee schwamm: i was reflecting on your comment about parkinson's. if you go to a neurology clinic, you will see a doctor one to every six months. i can see you for five minutes once a day to adjust medications, look for worsening,
but it would be time and money better spent and save a family 60 to 70 hours of travel and recovery, and the debilitating nurturer of the disease makes it -- nature of the disease makes it difficult. sen. bennet: that is fascinating and very practical. why are we seeing -- what are the distances doing the way you described? lee schwamm: the first is you don't get paid. the doctor doesn't get paid some of the patient spends a lot of money taking the day off of work having a loved one with them, waiting in the waiting room for not able toours, see someone at night or a time convenient. oris dr.-centered care hospital-centered care. we see so much to me and for telemedicine that we are seeing urgent care solutions pop up in existings of the
system. when we have reimbursement, you would see tremendous creativity meeting the needs of patients. thank you for that. we are taking steps to increase care coordination with multiple conditions. we were talking about examples. it would allow medicare advantage plans for supplemental design for chronically ill beneficiaries such as enhanced disease management. it makes sense for many seniors as they align with their doctor and prescription drug people. we would enroll 15% of the advantagest medicare beneficiaries in an accountable care organization rather than service land. hcl can work with them to better coordinate services and medications. what do you think we should keep in mind, anybody on the panel, as we work on our proposal and other proposals to better coordinate care for the sickest
patients? what should we avoid, and i think you actually have done us a lot of good by pointing out not enough of the health care system seems to be patient-centric. it is focused on the folks delivering the care. we love people who are, but this is about the patient that having to fight the system to get the care they need when they need the care so it is cheaper. do any of you have a meta-observation about what we need to keep in mind? the most important thing when we moved to the value-based purchasing and other measures is, what are the outcomes of measures? quality from whose perspective? is it patient reported outcomes? are the easy to measure because you can put them in the claims data? so many things need to be done that are meaningful, medically
meaningful, and they can have costs that we can monitor what we are doing. sen. bennet: anybody else? i'm out of time. sen. hatch: anybody else? greatovelace: one of the failures of the health care system is blaming the patient for compliance. it is people not being able to comply, not understanding what is suggested, not having the wherewithal. mcong more in the aco, partnership, people who use services need to be engaged actively rather than passively. some people wish they could participate, but they can't. sen. hatch: that is fine. you did fine. i have to say as chairman of this committee, this has been one of the best panels we have ever had. i have not asked any questions. i used to be a medical liability
defense lawyer, so i have dealt with a number of these problems. you folks have really covered this about as well as i have ever heard before. lves.t to commend yourse >> i very much show your respect. -- share your respect. this is the finance committee at its best. sen. hatch: [indiscernible] [laughter] sen. hatch: sorry. was giving youi the credit for bringing them. let me ask you one other issue we have talked a lot about in oregon. you talked on collaterally in this case, a big part of the challenge here is that a lot of these patients, with multiple chronic conditions, face challenges that bubbly don't fit but the quote medical box
clearly have ramifications for their health. i think someone mentioned access to transportation, certainly the inability to get access to good nutrition affects diabetes. in our part of the world, people always talk about the fact that you may have a patient with a heart problem, and is very hot and very humid, and they can't get access to an air conditioner. maybe a really cheap air conditioner would save enormous sums in terms of the person having to be hospitalized, and in effect, these are conditions that might not be technically medical. but just proportionally hurt people with multiple chronic conditions. so mrs. hayes, you are the one that touched on it.
could you describe as we wrap up, what you think the role is for services that don't fit the classic box of being medical but have enormous ramifications for a person's health? obviously the medicare advantage program is trying to incorporate some of that, but as we wrap up, what the chairman has correctly said, we have been an exceptional panel. we are counting on all of you to stay with us as we try to move this across the finish line. i think sometimes as i have talked to people, people have said -- excuse me, ron, you are going to pass a major medical bill in this kind of climate? we have put a lot of work into it. we have a cross-section of the senate represented on this committee, so we are calling on you for your help to get us across the finish line. hayesp if you would, mrs.
, your sense of what we ought to be doing in the long term as it relates to treatment for these services that don't probably fit the classic box. people always say cost line coverage. this is like an average. it sounds pretty good, the provider, but it probably isn't so great for the patient. what would you do for the patient in the area that we are talking about him of the classic need of an air conditioner for someone with a heart problem? i think one of: the most important components of this legislation is you are allowing for reimbursement under a benchmark or capitation system to cover anything that is reasonably related to improving or maintaining health and functional status so long as it is a part of a care plan
developed by a care team. this allows providers to sit down with patients, with family members, with their caregivers and talk to them about what they need. basing their care plan on what they need rather than medicare cost. --eone has suggested to me actually one of my staff said, are you telling me you would allow medicare to cover a dog walking service? i said, if a plan working under a capitated system determines it is better to bring in a dog walker for grandma on a day when there is six inches of snow to avoid a hit fracture, we should -- hip fracture, we should consider that within the payment box and at the benefit of the plan to provide these services. sen. wyden: why don't we do this, i know that senator warner has additional comments. would you show two or three of
the models that have been particularly good at picking up on this area that i am talking about, services that don't technically fit? could you furnish that? sen. hatch: senator, why don't you be the last one? >> i appreciate that, recognized sometimes after a membecos fm angeang i llryo te fl ve nus. i nto arbyhainyo anthrainemr d so r eism ppntg hn iks tsee ts. he grt odt re itayote e ol chad b iisnre whe opincoon gun, d wod cme bh of you to do anything i can to assist getting over the finish line, not only the value of this product but showing even in
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