HHS SECRETARY SEBELIUS ON THE ADMINISTRATION FOR COMMUNITY LIVING

FROM: DEPARTMENT OF HEALTH AND HUMAN SERVICES
April 16, 2012
A Statement from Secretary Sebelius on the Administration for Community Living

All Americans – including people with disabilities and seniors – should be able to live at home with the supports they need, participating in communities that value their contributions – rather than in nursing homes or other institutions.

The Obama administration and my department have long been committed to promoting community living and finding new mechanisms to help ensure that the supports people with disabilities and seniors need to live in the community are accessible. 

Today, with the creation of the new Administration for Community Living (ACL), we are reinforcing this commitment by bringing together key HHS organizations and offices dedicated to improving the lives of those with functional needs into one coordinated, focused and stronger entity.

The Administration for Community Living will bring together the Administration on Aging, the Office on Disability and the Administration on Developmental Disabilities into a single agency that supports both cross-cutting initiatives and efforts focused on the unique needs of individual groups, such as children with developmental disabilities or seniors with dementia. This new agency will work on increasing access to community supports and achieving full community participation for people with disabilities and seniors. 

The Administration on Community Living will seek to enhance and improve the broad range of supports that individuals may need to live with respect and dignity as full members of their communities. These support needs go well beyond health care and include the availability of appropriate housing, employment, education, meaningful relationships and social participation.

Building on President Obama’s Year of Community Living, the ACL will pursue improved opportunities for older Americans and people with disabilities to enjoy the fullest inclusion in the life of our nation.

PAHO SPEECH BY HHS SECRETARY KATHLEEN SEBELIUS

FROM:  DEPARTMENT OF HEALTH AND HUMAN SERVICES
PAHO Healthy Aging Conference
April 12, 2012
Washington, DC
Good morning and welcome.
For more than a century, the Pan American Health Organization has been a driving force behind many of our region’s greatest public health achievements, from reversing the spread of infectious diseases to improving nutrition, sanitation and access to clean water. And thanks to this kind of progress people are living longer and generally healthier lives than ever before.

In 1980, there were 378 million people in the world aged 60 or older. Three decades later, that figure has doubled. By 2050, it is projected to reach 2 billion -- with older people at about 22% of the global population, outnumbering children under 14 for the first time in human history. And these gains have not been limited to industrialized countries. The most rapid and dramatic demographic changes in the Americas are happening in low- and middle-income countries.
These trends represent a triumph of global public health, modern medicine and economic development.  And yet they also pose new challenges.

As people live longer, the shape of our families is changing. Adult children are caring for their aging parents, while raising their own families. Many of us work well past the “traditional” retirement age, by need or by choice, stretching our care giving capacities even further. And these shifts have begun to put new pressure on our countries’ health care systems and social safety programs, pushing policy-makers to find new ways to make limited resources go further.

We also know that as we live longer we’re more likely to develop multiple chronic non-communicable diseases. In the past more people died at younger ages from infectious diseases, accidents, and violence. Today, more and more of the world’s population are living long enough to face cancer, heart disease and Alzheimer’s.

Each year, chronic diseases kill 36 million people worldwide. That’s more than 3 out of every 5 deaths, robbing families and communities of loved ones and costing our economies billions.  Many of these diseases like diabetes, stroke, and respiratory disease are projected to affect even more people in the years and decades to come.
 
For years, our region has helped shape the international conversation about non-communicable diseases -- from the 2007 Declaration of Port-of-Spain -- to the resolution tabled by Trinidad and Tobago on behalf of the Caribbean Community that ultimately led to last year’s UN General Assembly High-Level Meeting.

Now the rest of the world is joining the conversation. And that’s critical because we still have a long way to go if we want to turn the tide on chronic disease. These threats recognize no national or political borders. They touch countries in every corner of the globe and at every stage in development.

So our challenge today is to prepare and respond. The good news is that we know what it takes to build communities where older citizens are not seen as a burden, but as experienced and engaged partners. And the work we do to support healthy aging also presents us with an opportunity to reshape our communities to promote better health at every age.

In the United States, we have embarked on an ambitious agenda to shift the focus of our health care system from waiting for people to become acutely ill to investing in prevention to keep them healthy in the first place.

In 2010, we passed a historic health reform law that improves access to the preventive care people need to stay healthy and the screenings they need to detect diseases early. And we’ve taken big steps to help seniors afford the cost of their medications.

We’re also working with doctors and hospitals to share their best methods for improving their patients' health.  Sometimes seemingly small things, like following up with a patient after she's been discharged from the hospital and helping all of her doctors better communicate with one another, make the biggest difference. And we're helping best practices like these spread to every corner of the country, so that everyone has access to the best care possible, no matter where they live.

But we also recognize that ensuring access to quality, affordable care is only one part of the job. Health also happens outside the doctor’s office – in neighborhoods, workplaces and community centers.

Just as important are the steps we can take to engage older people as we do this critical work: involving them in the design, execution, and leadership of programs for seniors -- and refuting any notion that as people age they have less to contribute or become helpless. Our growing population of older people is also increasingly diverse. Respecting this diversity is key to maintaining social connections, reducing isolation, and increasing people’s choices.

Ultimately, what drives our approach is a philosophy that says simply: “Nothing about them without them.”

And you can see it in successful initiatives like Stanford University’s Chronic Disease Self-Management Program -- built on more than two decades of federal research. The program recognizes that older people with chronic diseases should be more than just recipients of care. They should be key decision-makers in their own treatment.

So through workshops in community settings like senior centers, libraries, and at faith-based organizations, older people with a wide array of conditions come together to learn, share and build the skills they need to manage and improve their own health – from exercise and nutrition, to stress management and communicating with their health providers. At HHS, we’ve invested $27 million in grants to help communities implement these proven approaches.

The evidence shows that this program not only improves patients’ abilities to manage their own health, it has also improved health outcomes and even reduced health care costs. It is no wonder that the Stanford program is now available in at least 15 countries around globe.

What this kind of program tells us is that keeping older people healthy yields enormous dividends. When more people can participate more fully and contribute to society, everyone benefits.

And this is where we have an important opportunity to work together to share our best ideas and tools to keep our populations as healthy, productive and engaged as possible.
The United States is committed to learning from our partners across the region and around the globe. The more we work together, the faster we will be able to test new strategies, learn what works, and implement them in our own communities.

One of the striking aspects of my trips outside our country is how much eagerness there is to work together on health issues. When it comes to trade or foreign policy, there are often areas of strong disagreement. But when the discussion turns to tackling our biggest health challenges, there is a broad consensus that nations must work together. And when we do work together, we all benefit.

Healthy aging is an issue which aligns the interests of the countries around the world.   A healthier world is one in which every nation will have more productive workers, longer lives, and more vibrant communities.

Too often when we talk about global aging, we talk about its costs. But by keeping our seniors healthy and engaged we have begun to write a new story, where every older person gets the dignity and independence they deserve and every nation thrives.

SECRETARY OF HHS KATHLEEN SEBELIUS SPEAKS AT NATIONAL HEALTH PROMOTION SUMMIT

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
DELIVERED BY SECRETARY OF HEALTH AND HUMAN SERVICES KATHLEEN SIEBELIUS
National Health Promotion Summit
April 10, 2012
Washington, DC
I’m glad to be with you this morning because I believe nothing is more important to America’s future than our health.  On a national level, you can look at any of our biggest goals as a country – increasing productivity and economic growth, making our businesses more competitive around the world, helping our children succeed in school, reducing our government deficits.  Improving health contributes to every single one of them.

On an individual level, health is fundamental to opportunity.  The healthier we are, the more freedom we have to pursue our dreams and contribute to our families and communities.  A healthier country is one in which many more Americans have the chance to reach their full potential.

We have a clear and powerful national interest in promoting our country’s health.  And we know from decades of research that the most effective way to do that is prevention.  It’s not only easier to keep people healthy than treat them once they get sick.  It’s usually less costly too.

And yet, as you know better than anyone, we have often treated prevention as an afterthought in this country.  When this Administration came into office, prevention and public health accounted for less than 4 cents out of every health care dollar.
There were many reasons for this.  The benefits of prevention can take a while to appear.  When a dramatic surgery saves the life of a heart attack victim, we see the results right away.  When a healthy diet helps prevent a deadly heart attack, it may not show up until years later as a data point in a study.

Health promotion is also complicated.  There is no prevention pill.  Instead, we know that health can be affected by everything from the air we breathe, to the food we eat, to the neighborhood we live in, to our job and income, to our family background.  It can be hard to know where to start.

As a result, prevention too often became a talking point – an idea that generated lots of conversation but not enough action, especially from the federal government.
Today, I’m proud to say that this is changing.  While much more work remains to be done, this Administration has made prevention a top priority – and an integral part of our health strategy – beginning in our first days in office.

From the First Lady’s historic Let’s Move campaign, to the Recovery Act’s community health investments, to the health care law, to a new emphasis on environmental justice, to a first of its kind National Prevention Strategy – we have made prevention a focus for the federal government over the last three years in a way it has never been before.
And that means the entire federal government.  Prevention is no longer just the work of health agencies.  Our National Prevention Strategy was developed with input from the Departments of Transportation, Education, Housing and Urban Development and more.  And it gives these agencies responsibilities too.

So for those of you working on the front lines to promote better health in cities and towns across the country, my pledge to you this morning is that this Administration is going to be your partner.  And today, I want to focus on one of the areas where we have the biggest opportunity to make a difference together, which is our work to reduce tobacco use.

It has now been nearly 50 years since the first Surgeon General’s report on the dangers of smoking.  Back then, in the America I grew up in, smoking was everywhere: on airplanes, in offices, at the dinner table.  Nearly half of all Americans were smokers.
The work we have done since then to reduce smoking rates is one of the great health triumphs of the last century.  A report from the National Cancer Institute earlier this year found that between 1975 and 2000, these efforts saved the lives of 800,000 Americans who would have otherwise died of lung cancer.  And that’s looking at a single disease in a 25 year window.

In the late 90s, it looked like this progress would continue as states invested money from the master settlement agreement and tobacco excise taxes in anti-tobacco ad campaigns and other prevention efforts.  There was a feeling that tobacco use was on an inevitable decline.

But then we saw a pattern that is too familiar in prevention.  Budgets tightened, and resources started getting diverted to areas with a more visible and immediate payoff.  By the time this Administration came into office, smoking rates that had been falling for decades were stalled.

Today, smoking remains the leading cause of preventable death, killing an estimated 443,000 Americans – more than died in all of World War II – each year.  And for every person who dies from smoking, at least two young smokers take their place. In total, nearly 4,000 young people smoke their first cigarette every day, beginning what may become a deadly addiction before they’re even eligible to vote.

This was the challenge facing the country when this Administration came into office.  But there was some good news too: we knew what worked.  In large part because of the incredible work many of you have done in states and communities, we already had a set of proven interventions that we knew could prevent illness and save lives.
We know comprehensive smoke-free laws work because states and cities that have put them in place have seen hospitalizations from heart attacks drop an average of up to 17 percent.

We know that helping people quit works because when Massachusetts expanded tobacco cessation benefits for Medicaid recipients, their smoking rates were cut by 26 percent.
And we know how effective comprehensive tobacco control programs can be because California’s has brought smoking levels down to near 12 percent.
These interventions save lives.  And they save money too.  On average, smokers have $2,000 more in health care costs a year than the general population.  That means every time we keep a young person from starting, we could be saving more than $100,000 over his or her lifetime.  At a time when health care costs have become one of the biggest items on the budgets of families, businesses, and state and federal government, we can’t afford not to expand these efforts.

So over the last three years, that’s exactly what we’ve done.  In areas where the federal government can make a difference, we’re stepping up.  For example, using the new regulatory powers it got in the 2009 tobacco control legislation, the FDA is now restricting the use of misleading terms like light or low-tar.
Beginning next year, they’ll also require tobacco companies to disclose the quantities of harmful and potentially harmful chemicals that they put in their products.  Today, we know everything about the food we put in our bodies down to the food coloring but have little idea what’s in our cigarettes.  That’s going to change.

And FDA has also announced a final rule that will require that cigarette packaging and ads to carry new warning graphic warning labels.  This is the most significant change to cigarette warnings in 25 years in the United States, and it ensures that when people pick up a pack of cigarettes, they’ll have much better information about the risk they’re taking.
We’re also doing more to help the 45 million Americans who already smoke quit – something nearly 70 percent of them say they want to do.  We know from new research that even long-time smokers’ bodies begin to heal almost immediately if they quit.  After just 24 hours, their chances of having a heart attack drop.  Within a few weeks, their lungs are working better.

So we’re making it easier for people to break their tobacco addictions.  All Americans in new health plans can now get smoking cessation counseling without paying a co-pay or deductible.   And we’ve changed a Medicare policy that forced beneficiaries to wait until after symptoms started to appear to get help quitting.  Now, seniors can get help before they get sick.

Last month, we also did something that the federal government has never done before: we launched a national tobacco control media campaign.  We estimate the new ads will lead more than half a million smokers to seek out the resources they need to quit, saving $170 million over the next three years.  And I’m happy to report that in the week after the campaign went on the air, we saw the number of calls to our national quit line more than double.

These are all steps it makes sense to take at the federal level.  But we also recognize that most of the work in our battle against tobacco use has and will continue to happen at the state and local level.  So with funding from the Recovery Act and the health care law, we’re funding proven community efforts like establishing smoke-free policies in parks and housing projects that we hope can become national models.  We’re reaching out to employers too, helping them establish smoke-free workplaces that improve health and productivity.  And we’re working with states to step up inspections to ensure that retailers don’t sell tobacco products to kids.

Our approach, in other words, is to take every proven intervention we have – and then do them all.  That’s important because, personal decisions around tobacco use are not easy.  One person may quit because they see an ad on television.  Another may stop because of the inconvenience of not being able to smoke at their workplace or favorite restaurant.  A third may kick the habit with the help of a counseling program.  But more often, it’s a combination of all these factors that helps people break their addictions.  That means we need to cover all the bases.

When you put all these steps together, this is the most ambitious federal tobacco control effort in several decades.  But there is much more work to be done.  If we are going to get tobacco rates falling again, we need to continue to expand smoke-free policies.  We need health care providers to treat start treating tobacco addiction like the potentially deadly condition it is and refer their patients to resources that can help them quit.  We need more employers to cover tobacco cessation treatment in their health plans, for the sake of their employees and their bottom lines.  We need retailers to continue their efforts to avoid selling tobacco to youth.
If we can do all of this, I believe we have a real shot to achieve our Health People 2020 goal of cutting the share of Americans who smoke to 12 percent.  It won’t be easy, but the payoff would be huge.  Even if we only got halfway to that goal, we would save millions of lives and hundreds of billions of dollars.

And that’s just tobacco.  We’re also seeing new progress in areas from HIV/AIDS, where a new national strategy is in place, to childhood obesity, where the First Lady and others have helped inspire a new sense of urgency and spirit of partnership.
In all these prevention efforts, we’re guided by a few key principles.
First, we need to commit the resources.  Prevention cannot just be a talking point.
Second, we need to focus those resources on the interventions that have proven to be effective.  We need to pay close attention to the latest science – like the recent discovery that HIV/AIDS treatment is itself one of the best forms of prevention – and let that science inform our work.
Third, we can’t rely on any one intervention.  There are no silver bullets.  We need a comprehensive approach.

Fourth, no organization can do it on its own.  It needs to be the federal, state and local government, schools, the business community, health care providers, community-based organizations, researchers, families and individuals all working together.
Fifth, and most important, we need to sustain these efforts.  We have seen time and time again in public health, from tobacco to TB to HIV/AIDS, that we cannot coast to better health.  We need to keep our foot down on the accelerator.

No one would ever propose giving our kids half an immunization.  Or purifying half a city’s water supply.  And we should be just as insistent when it comes to sustaining other life-saving prevention programs too.

We know it will not be easy.  But we can no longer afford - from a financial perspective or a health perspective – to rely on delivering better care in intensive care units and emergency rooms as our primary strategy for improving health.  It’s about time we as a country got serious about prevention, and this Administration is going to work with you every step of the way to make that happen.
Thank you.

HHS SECRETARY SPEECH ON MEDICARE FRAUD

FROM:  DEPARTMENT OF HEALTH AND HUMAN SERVICE
SECRETARY KATHLEEN SEBELIUS
Chicago Fraud Prevention Summit
April 4, 2012
Chicago, IL
Thank you.
As you know, the work we’re doing together here today – sharing best practices and developing new strategies – is part of a national conversation that began in January 2010 at the first Health Care Fraud Prevention Summit and has continued across the nation.
It was President Obama who asked us to come together. When he came into office, we were, frankly, falling behind. Scams were getting bigger and more sophisticated. Criminals were being more creative and going after larger sums. They were evolving, and we needed to catch up.

So over the last three years that is exactly what we’ve done.
Attorney General Holder just spoke about law enforcement’s strong commitment to stamping out fraud. More boots on the ground has meant more criminals locked up, more schemes taken down, and a stronger health care system for the rest of us.
But we're not just prosecuting fraud. We're also taking steps to prevent it.
In the past, nearly anyone could fill out a form and become a Medicare provider. In a matter of weeks, criminals could set up false clinics, enlist willing accomplices and vulnerable seniors to submit false claims and begin collecting payments. For industrious criminals, this approach was a ripe target.
But that‘s no longer the case. Over the last three years we have made our health care system dramatically less appealing to those who once had thought of stealing from Medicare and Medicaid as easy money.
Today, I want describe how this transformation took place.
To begin, it’s now a lot more difficult for bad actors to get their foot in the door.
Today, before you can become a Medicare provider, you have to go through a rigorous third-party review process that will make sure you meet all the requirements to bill Medicare.
We have a comprehensive database that allows us to systematically screen all current and prospective providers against other key sources like provider licensing and criminal records. If you get banned from one Medicaid program or Medicare, you get banned from all Medicaid programs.

And if a doctor retires, dies, or becomes ineligible, we know about it and can remove his information from our system. In the past, out-of-date and invalid provider numbers would remain on the rolls -- like a forgotten backdoor entrance allowing criminals to sneak in and start billing bogus claims. But no longer.

I am proud to announce today that we have already removed 3,000 ineligible providers from the Medicare program identified in just the first month of these new screening procedures.

But that’s just our first line of defense. We’re also working to make sure that even if criminals do find their way into the system, it’s a lot harder to get away with taxpayer dollars.
In the past, government was often two or three steps behind perpetrators, quickly paying out nearly every properly submitted claim -- then later trying to track down the bad guys after we got a tip. That meant we were often showing up after criminals had already skipped town, taking all of their fraudulent billings with them.
But new data analysis tools allow us to analyze claims in real time, taking away criminals’ head start. Instead of the old ‘pay-and-chase’ model, we’re getting proactive by using a technology similar to the one credit card companies use to identify and stop suspicious payments before they go out. So now, just as Visa can put your card on hold when it is used to buy ten flat screen TVs, we have the ability to freeze questionable payments until we can investigate.

Since this system was put in place, we have stopped, prevented, or identified $30 million in payments that should never have been made. And because the system is designed to get smarter over time, it’s only going to be more effective in the future.
We’re also making it easier for law enforcement officials from the FBI, the Inspector General Office’s and local jurisdictions to share data and access claims information as soon as they are submitted to Medicare.

Under the old system, it was as if police officers in one town weren’t talking to the officers in the next town. Now, we’re all beginning to plug into the same system in real time, so we can respond with the same speed and agility as the criminals.
This new fraud prevention system has changed the equation for any criminal. But we also know that neither law enforcement, nor federal officials are going to stop fraud alone. And no law or technology is as effective at preventing fraud as consumers who are educated and informed.

So with the support of partner organizations across the country, thousands of Senior Medicare Patrol volunteers are giving their friends and neighbors the tools to recognize, resist, and report fraud.

Millions of beneficiaries have taken advantage of the program’s one-on-one or group counseling sessions and over 25 million people have received fraud prevention information through SMP community outreach events.
And it’s clear that this kind of outreach pays off.
In 2010, a home health agency set up an office in the lobby of a Chicago-area affordable senior housing building and offered free blood pressure checks. In the process, they collected seniors’ Medicare numbers.

One of those seniors later noticed something wasn’t right when she reviewed her Medicare Summary Notice. The home health agency had billed Medicare for more than $1,400 in skilled nursing services that she believed she never received. So she contacted the Illinois SMP and they helped her file a complaint.

The complaint triggered an investigation. And the investigation uncovered far more than a single isolated incident, leading Medicare to recoup more than $62,000 in inappropriate payments. Just as importantly, it ended a scheme that, if allowed to continue, could have drained thousands if not millions more from Medicare’s coffers.

And it all started with one cautious citizen who – thanks to the outreach and education of the local Senior Medicare Patrol -- knew to speak up when something wasn’t right.
From 2010 to 2011 the number of calls to the Illinois SMP rose 64 percent and the trend has continued into 2012. And as these numbers increase, the good news is that more and more of them are coming from seniors who are already putting into practice what they have learned from their neighbors, a local presentation, or ‘Fraud Alert’ emails. When someone calls on the phone or knocks on the door asking for their Medicare number, they know to refuse, and then to report it immediately.
This also serves to remind us that no one group, agency, or business owns all of the resources or expertise we need to keep criminals out of our health care system.
Because we all have a stake in preventing health care fraud, we’re all doing our part.
For someone thinking about committing fraud, this means the health care landscape looks a lot less friendly today:

It’s harder than ever to get into the system as a bad actor. Get in and it’s harder still to submit a fraudulent claim. Find a way to submit a claim and you are more likely to get caught. And when you get caught, you’re going to face a tougher punishment.
There is no responsibility that this Administration takes more seriously than safeguarding taxpayer dollars. I am proud of how far we have come. And I look forward to working with all of you in the days and months ahead to build on that progress and protect our health care system for this generation and the next.