AFFORDABLE INSURANCE EXCHANGES MOVING FORWARD

FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

States continue to move forward, build Affordable Insurance Exchanges

August 23, 2012
　
Today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that California, Connecticut, Hawaii, Iowa, Maryland, Nevada, New York, and Vermont have received new grants to help support the establishment of Affordable Insurance Exchanges. Starting in 2014, consumers and small businesses will have access to high-quality, affordable health insurance through an Exchange – a one-stop marketplace where consumers can choose a private health insurance plan that fits their health needs and have the same kinds of insurance choices as members of Congress.

"We continue to support states as they move forward building an Exchange that works for them," Secretary Sebelius said. "Thanks to the health care law, Americans will have more health insurance choices and the ability to compare insurance plans."

In every state, Exchanges will allow consumers to shop for and enroll in private health plans that meet their needs. Consumers will be able to learn if they are eligible for tax credits and cost-sharing reductions, or other health care programs like the Children’s Health Insurance Program. Small employers will be eligible to receive tax credits for coverage purchased for employees through the Exchange. These competitive marketplaces make purchasing health insurance easier and more understandable and offer consumers and small businesses increased competition and choice.

Today’s awards will give states additional resources and flexibility to establish an Exchange. California, Hawaii, Iowa, and New York today have been awarded Level One Exchange Establishment grants, which provide one year of funding to states that have begun the process of building their Exchange. Connecticut, Maryland, Nevada, and Vermont were awarded Level Two Establishment grants, which are provided to states that are further along in building their Exchange and offers funding over multiple years.

Previously, 49 states, the District of Columbia and four territories received grants to begin planning their Exchanges. With today’s awardees, 34 states and the District of Columbia have also received Establishment grants to begin building their Exchanges.

On June 29, HHS announced a funding opportunity providing states with 10 additional opportunities to apply for funding to establish a state-based Exchange, state Partnership Exchange, or prepare state systems for a Federally-facilitated Exchange. States can apply for Exchange grants through the end of 2014, and may use funds during the initial start-up year. This schedule ensures that states have the support and time necessary to build an Exchange that best fits the needs of their residents.

CUTTING RED TAPE AND SAVING $9 BILLION ON HEALTH CARE

Photo:  Secretary of HHS Kathleen Sebelius
FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Obama administration issues new rules to cut red tape for doctors and hospitals, saving up to $9 billion
Health and Human Services (HHS) Secretary Kathleen Sebelius announced today the release of a new rule that will cut red tape for doctors, hospitals, and health plans. In combination with a previously issued regulation, the rule will save up to $9 billion over the next ten years. The regulation adopts operating rules for making health care claim payments electronically and describing adjustments to claim payments.

"These new rules will cut red tape, save money and ensure doctors spend more time seeing patients and less time filling out forms," said Secretary Sebelius.

Studies have found that the average physician spends three weeks a year on billing and insurance related tasks, and, in a physician’s office, two-thirds of a full-time employee per physician is necessary to conduct these tasks. Many physician practices and hospitals receive and deposit paper checks, and manually post and reconcile the health care claim payments in their accounting systems. By receiving payments electronically and automating the posting of the payments, a physician practice and hospital’s administrative time and costs can be decreased.

The operating rules build upon industry-wide health care electronic fund transfer (EFT) standards that HHS adopted in January of this year. Together, the previously issued EFT standards and the EFT and electronic remittance advice (ERA) operating rules announced today are projected to save between $2.7 billion and more than $9 billion in administrative costs over ten years by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans.

Operating rules include best business practices on how electronic transactions are transmitted and often target obstacles that physician practices and health insurers have with using electronic transactions. For instance, the rule announced today requires insurers to offer a standardized, online enrollment for EFT and ERA so that physicians and hospitals can more easily enroll with multiple health plans to receive those transactions electronically. The rule also requires health plans to send the EFT within a certain amount of days of the ERA, which helps providers reconcile their accounts more quickly.

Today’s rule, Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions were developed through extensive discussions with industry stakeholders. The rule adopts the Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE) Phase III EFT & ERA Operating Rule Set, including the CORE v5010 Master Companion Guide Template, with the exception of Requirement 4.2 of the Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule. Collectively, these rules are referred to as the EFT & ERA Operating Rule Set.

HHS SAYS MEDICARE PRESCRIPTION DRUG PREMIUMS WILL REMAIN STEADY

FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Medicare prescription drug premiums to remain steady for third straight year
Coverage improves and out-of-pocket savings grow as a result of the health care law

Coverage basic premiums for Medicare prescription drug plans are projected to remain constant in 2013, Health and Human Services Secretary (HHS) Kathleen Sebelius announced today. The average 2013 monthly premium for basic prescription drug coverage is expected to be $30. Average premiums for 2012 were projected to be $30 and ultimately averaged $29.67. At the same time, since the law was enacted, seniors and people with disabilities have saved $3.9 billion on prescription drugs as the Affordable Care Act began closing the "donut hole" coverage gap.

"Premiums are holding steady and, thanks to the health care law, millions of people with Medicare are saving an average of over $600 each year on their prescription drugs," said Secretary Sebelius.
Today’s projection for the average premium for 2013 is based on bids submitted by drug and health plans for basic coverage during the 2013 benefit year, and calculated by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary.

The upcoming annual enrollment period -- which begins Oct. 15 and ends Dec. 7, 2012 – allows people with Medicare, their families and their caregivers to choose their plans for next year by comparing their current coverage and quality ratings to other plan offerings. New benefit choices are effective Jan. 1, 2013.

Because of the Affordable Care Act, out-of-pocket savings on medications for people with Medicare continue to grow. Last month, CMS announced that more than 5.2 million people with Medicare have saved over $3.9 billion on prescription drugs in the Medicare Part D donut hole since the law was enacted. In the first half of 2012, over 1 million people with Medicare saved a total of $687 million on prescription drugs, averaging $629 per person this year.

As a result of the Affordable Care Act, coverage for both brand name and generic drugs in the coverage gap will continue to increase over time until 2020, when the coverage gap will be fully closed. This year, people with Medicare received a 50 percent discount on covered brand name drugs and 14 percent coverage of generic drugs in the donut hole. In 2013, Medicare Part D’s coverage of brand name drugs will begin to increase, meaning that people with Medicare will receive a total of 52.5 percent off the cost of brand name drugs (a 50 percent discount and an additional 2.5 percent in coverage) and coverage for 21 percent of the cost of generic drugs in the donut hole.

SECRETARY OF HHS SEBELIUS GIVES SPEECH ON BULLYING PREVENTION

FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Partners in Bullying Prevention Summit

August 6, 2012
Washington, DC
Thank you for that warm welcome – but more importantly for your commitment to giving our young people the safety and support they need to grow and thrive.
Two years ago we came together for the first-ever National Bullying Summit with 150 state, local, civic and corporate leaders. And we began to map out a comprehensive national plan to end bullying.
There had been efforts in the past to confront bullying. At the Department of Health and Human Services, our Health Resources and Services Administration launched an educational campaign that reached young people everywhere from elementary and middle schools to Boys and Girls Clubs and 4-H clubs. The Department of Justice conducted outreach through its Office of Juvenile Justice and Delinquency Prevention and fought to protect bullied students’ civil rights in the courtroom.
The Department of Education worked with state departments of education and local school boards to collect better data and develop anti-bullying policies. And we saw private campaigns and non-profit institutions step up like PACER’s National Center for Bullying Prevention.
All of these efforts were making an impact and reaching young people in need. Yet, we also recognized that despite such a wide array of programs and campaigns, bullying still wasn’t being treated as a national priority.
So we convened the first Summit two years ago where we said, for the first time, that bullying was a serious national challenge requiring a true national response.
Around the same time, our nation faced a number of tragic incidents involving children and teenagers who, having been bullied, felt like they had nowhere to turn and took their own lives. It seized the nation’s attention. And for many, it was a wakeup call. Bullying is not just a harmless rite of passage, or an inevitable part of growing up. It threatens the health and well-being of our young people. It’s destructive to our communities and devastating to our future.
Spurred by these incidents and a new national focus, cities and states began taking aggressive action against bullying. School districts adopted broad anti-bullying resolutions that called on staff to intervene when they witness harassment or teasing. State legislatures passed new anti-bullying laws and strengthened existing ones. In 2009 and 2010 alone, 36 state anti-bullying laws were enacted or amended.
Outside of government, organizations from the National Education Association and Parent Teacher Association to the Cartoon Network launched their own anti-bullying campaigns. And brave young people began stepping up to be leaders, protecting one another in their own communities. I know some of you are here today and I want to thank you for your leadership.
All of this momentum is encouraging. But we also know that our work has only just begun.
Today, one out of five high school students reports being bullied on school property. And as youth spend more of their time on Facebook, email, and text messages, there are more opportunities to bully each other, while hiding it from teachers and parents.
In too many communities bullying is still the norm. More adults may be stepping in to stop it, and more young leaders have stepped up. These actions are important and they can make powerful and lasting impressions. But if we’re going to prevent bullying on a national scale, we must take our efforts deeper still, and work systematically to prevent bullying as early as possible.
We know that the federal government cannot solve these problems on its own. But there are some steps it can take to give you the tools -- especially at this pivotal moment -- to translate today’s unprecedented awareness into action. Let me tell you about some of the ways we’re working to do exactly that.
First, we recognize that there is still a lot more to learn about bullying.
For many years, our understanding was limited to anecdotal evidence, and a scattering of state and local surveys. But we have had very few rigorous scientific studies about the specific factors that put youth at risk for bullying or the specific steps that can protect them.
But that is changing. Our Centers for Disease Control and Prevention have incorporated bullying to its Youth Risk Behavior Survey, the agency’s biennial survey of schools across the country about student health behavior. With new questions in the survey, we have a national picture of how many young people experience bullying and its connection to other risk factors. As the survey is repeated every two years we will be able to measure our progress.
Now as we go forward, we also want to make sure we’re speaking the same language as all of our partners. So we’re working closely with the Department of Education to develop a standard definition of bullying, to get a more accurate and consistent picture of bullying’s prevalence and connection to other health risks. We hope to finalize this effort before the end of the year.
Second, we’re giving people the support to become bullying prevention leaders in their own communities.
Over the years, experts from our Health Resources and Services Administration have gone out to communities where they have trained school staff, coaches, parents and youth about the best practices of bullying prevention.
But we were limited in how many people we could reach directly. We knew that bullying was taking place in nearly every community in America, and we didn’t have the resources to go everywhere.
We do however have the tools to empower community leaders with the best information and expertise to train and lead their own colleagues and neighbors. That’s the idea behind the new Training Module we’re making available for the first time today on Stopbullying.gov.
Over and over again we’ve heard from local leaders who say ‘I want to establish a bullying prevention plan for my community, but I don’t know where to begin.’ Now, they have a great place to begin. They can download this research-based training right from the website, adapt it to their own needs and deliver it at their own trainings and community events. The training module is also paired with a Community Action Toolkit that leaders can use to develop and roll out more comprehensive prevention strategies tailored to their own communities’ needs.
This is just the latest terrific resource available on stopbullying.gov, which has become the country’s one-stop shop for bullying prevention tools. Its resource database includes more than 100 proven tool-kits, fact sheets, articles and program directories.
And it’s not just for policy makers like us: Stopbullying.gov is a great starting point for young adults, teens, parents, and anyone who works with young people. There is a revamped section for kids. And for young people who might be thinking about hurting themselves, the website shows them where they can get immediate help.
Now, we’ve also been focusing on the media. For many reporters and producers, bullying is a new topic. Some are still informed by outdated notions that bullying may be harmless or unavoidable. Others may see the tragedy of the single child victimized by a bully, but fail to recognize its far deeper impact on public health and public safety.
So our Substance Abuse and Mental Health Services Administration has launched a task force of both journalists and experts in bullying prevention. They’re working together to create background material, guidelines and other resources for journalists, bloggers, producers, and writers who cover bullying. Our goal is to help them provide accurate information so that Americans can understand what is truly going on among our youth, and learn how they can make a difference.
I want to close by thanking all of you again for your leadership and your partnership. This may be only our 3rd Annual Summit, but I know many of you have been working on these issues for many years. Bullying is not new. These are behaviors that have been around a long time. They are attitudes that have been handed down from one generation to the next.
What we need now are not just stronger programs and more persuasive campaigns – although they are critical. We also need to continue changing a culture that too often says, "It’s not my responsibility."
We must do more. Building safe neighborhoods and schools where young people can thrive is a job for all of us -- not just government or schools or parents. We are all responsible. And no one can afford to be a bystander.
As a mother, I have seen the awful power of bullying on young people. And I know that any parent would move heaven and earth to defend her child from the pain and fear a bully might cause. Together, we can build a nation, where every single child, no matter who she is or where he lives, gets that same protection and support.
Thank you.

HHS ANNOUNCES 89 NEW ACCOUNTABLE CARE ORGANIZATIONS

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
HHS announces 89 new Accountable Care Organizations
2.4 million people with Medicare to receive better, more coordinated care
Health and Human Services (HHS) Secretary Kathleen Sebelius announced today, that as of July 1, 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C.  ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare.

These 89 new ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care.

“Better coordinated care is good for patients and it saves money,” said Secretary Sebelius. “We applaud every one of these doctors, hospitals, health centers and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care.”

Participation in an ACO is purely voluntary for providers.  The Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs, is made possible by the 2010 Affordable Care Act.  Federal savings from this initiative could be up to $940 million over four years.

“This new group of ACOs adds to a solid foundation,” said Centers for Medicare & Medicaid (CMS) Acting Administrator Marilyn Tavenner. “The Medicare ACO program opened for business in January and, already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives.”

The 89 ACOs announced today bring the total number of organizations participating in Medicare shared savings initiatives to 154, including the 32 ACOs participating in the testing of the Pioneer ACO Model by CMS’s Center for Medicare and Medicaid Innovation (Innovation Center) announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011.  In all, as of July 1, more than 2.4 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.

The selected ACOs operate in a wide range of areas of the country and almost half are physician-driven organizations serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs.   Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving.

To ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely, an ACO must meet quality standards.  For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.

Beginning this year, new ACO applications will be accepted annually.  The application period for organizations that wish to participate in the MSSP beginning in January 2013 is from Aug. 1 through Sept. 6, 2012.  More information, including application requirements, is available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Application.html

HHS SECRETARY SEBELIUS'S REMARKS ON FDA SAFETY AND INNOVATION ACT

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Statement from HHS Secretary Kathleen Sebelius on the signing of the Food and Drug Administration Safety and Innovation Act
Today, the President signed into law S. 3187, the “Food and Drug Administration Safety and Innovation Act.”  This legislation, which passed both the House and Senate with overwhelming bipartisan majorities, will help speed safe and effective medical products to patients and maintain our Nation’s role as a leader in biomedical innovation.

S. 3187 is the culmination of the work of the administration and Congress, in partnership with patients, the pharmaceutical and medical device industries, the clinical community, and other stakeholders, to provide the Food and Drug Administration with the tools needed to continue to bring drugs and devices to market safely and quickly and promote innovation in the biomedical industry, and to help secure the jobs supported by drug and device development.

This legislation will drive timely review of new innovator drugs and medical devices, implement the program proposed in the 2013 President’s Budget to accelerate approval of lower-cost generic drugs, and fund the new approval pathway for biosimilar biologics created by the Affordable Care Act.  These new programs are important to increasing patient access to affordable medicines.

S. 3187 also enhances the tools available to the FDA to combat drug shortages by requiring manufacturers of certain drugs to notify the FDA when they experience circumstances that could lead to a potential drug shortage.  This is consistent with the administration’s request to Congress to complement the actions directed by the 2011 Executive Order to address this significant public health issue.

Provisions in the legislation also will help enhance the safety of the drug supply chain in an increasingly globalized market, increase incentives for the development of new antibiotics, renew mechanisms to ensure that children’s medicines are appropriately tested and labeled, and expedite the development and review of certain drugs for the treatment of serious or life-threatening diseases and conditions.

While enactment of S. 3187 marks an important moment for innovators across industry, research and clinical care settings, its most important beneficiaries are the patients and families that will be helped by the next generation of affordable medical products this bill will help to foster.

HHS GRANTS $971 MILLION FOR PUBLIC HEALTH DISASTER PREPAREDNESS

Photo Credit:  Wikimedia.
FROM:  DEPARTMENT OF HEALTH AND HUMAN SERVICES
HHS grants bolster health care and public health disaster preparedness
Systems prepared for emergencies can provide better daily care
The Department of Health and Human Services has awarded more than $971 million to continue improving preparedness and health outcomes for a wide range of public health threats within every state, eight U.S. territories, and four of the nation’s largest metropolitan areas.

“Health care and public health systems that are prepared to respond successfully to emergencies and recover quickly from all hazards are also able to deliver services more effectively and efficiently every day,” said Dr. Nicole Lurie, HHS assistant secretary for preparedness and response. “Having systems in place to provide better treatment for disaster survivors and improved public health for our communities also leads to better health outcomes on a day-to-day basis.”

The funding awards included a total of approximately $352 million awarded for the Hospital Preparedness Program (HPP) cooperative agreement and more than $619 million awarded for the Public Health Emergency Preparedness (PHEP) cooperative agreement.

Administered by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR), HPP funding supports preparedness for health care systems, health care coalitions, and health care organizations. HHS’ Centers for Disease Control and Prevention administers PHEP funding to support the preparedness of state, local, and territorial public health systems.

HPP and PHEP funding helps recipients build and sustain public health and health care preparedness capabilities outlined in ASPR’s Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness (PDF – 902 KB) and in CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning. These documents establish standards for protecting human health and national health security.

For the first time, the HPP and PHEP funds are being awarded jointly, encouraging cooperation between the nation’s health care and public health systems. This change follows a year-long effort by ASPR and CDC to align the two federal preparedness programs. These programs represent critical sources of funding and support for public health and health care preparedness systems.

Improved coordination among federal emergency preparedness programs is a high priority of HHS and other federal entities, as well as for HPP and PHEP awardees. In December 2010, ASPR, CDC, and other federal partners began developing strategies to better align grants with public health and health care preparedness components.
“State and local agencies have made tremendous progress over the past decade in building and sustaining public health and health care preparedness capabilities,” Dr. Lurie said. "The integration fostered by HPP and PHEP alignment is important in streamlining and strengthening the day-to-day relationships and cross-sector cooperation that are critical to achieving a resilient health system ready to face any health hazard and capable of providing the affordable, high-quality daily care that all Americans deserve.”

With aligned HPP and PHEP cooperative agreement programs, states and communities can more easily, efficiently, and effectively conduct joint planning, exercising, and program operations. These activities are vital in preparing communities to respond and recover from emergencies and help communities manage health care and public health on a daily basis.

Dr. Lurie noted that as access to health care increases, more Americans are likely to seek care from primary care providers and health clinics to address these day-to-day health issues rather than visiting emergency departments. With fewer people seeking basic care in emergency rooms, hospitals can care for a greater number of patients during emergencies.
ASPR and CDC aligned HPP and PHEP cooperative agreements to advance all-hazards preparedness and national health security, promote responsible stewardship of federal funds, and reduce the administrative burden for grant recipients. The programs support complementary preparedness capabilities and performance measures, use the same processes for grants administration, technical assistance and data management, use common reporting requirements, and have compatible IT systems.

While closely aligned in many aspects, HPP and PHEP will continue to remain individual programs, in accordance with authorizing legislation. HPP and PHEP budgets also will remain separate, to ensure accountability for the statutory requirements of each separate funding stream.

This alignment has resulted in several key changes for the 2012 HPP-PHEP grant cycle. Among the changes are a single HPP-PHEP funding opportunity announcement, funding application, and grant award, as well as a single grants administration agency, CDC’s Procurement and Grants Office. An aligned grant cycle is also being implemented, with the annual HPP-PHEP grant cycle beginning each July 1 and ending on June 30 of the following year.

To learn more about HPP and PHEP including grant awards to individual states, territories or localities, visithttp://www.cdc.gov/about/organization/ophpr.htm.

HHS SAYS HEALTH CARE LAW HAS SAVED OVER $1 BILLION

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health care law saves consumers over $1 billion
Health care law provides rebates to more than 12 million consumers
Today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that 12.8 million Americans will benefit from $1.1 billion in rebates from insurance companies this summer, because of the Affordable Care Act’s 80/20 rule.  These rebates will be an average of $151 for each family covered by a policy.

The health care law generally requires insurance companies to spend at least 80 percent of consumers’ premium dollars on medical care and quality improvement. Insurers can spend the remaining 20 percent on administrative costs, such as salaries, sales, and advertising. Beginning this year, insurers must notify customers how much of their premiums have been actually spent on medical care and quality improvement.

Insurance companies that do not meet the 80/20 standard must provide their policyholders a rebate for the difference no later than Aug. 1, 2012.  The 80/20 rule is also known as the Medical Loss Ratio (MLR) standard.

"The 80/20 rule helps ensure consumers get fair value for their health care dollar," Secretary Sebelius said.
Consumers owed a rebate will see their value reflected in one of the following ways:
a rebate check in the mail;a lump-sum reimbursement to the same account that they used to pay the premium if by credit card or debit card; a reduction in their future premiums; or their employer providing one of the above, or applying the rebate in a manner that benefits its employees.


Insurance companies that do not meet the 80/20 standard will send their policyholders a rebate for the difference no later than Aug. 1, 2012. Consumers in every state will also receive a notice from their insurance company informing them of the 80/20 rule, whether their company met the standard, and, if not, how much of difference between what the insurer did or did not spend  on medical care and quality improvement will be returned to them.

For the first time, all of this information will be publicly posted on HealthCare.gov this summer, allowing consumers to learn what value they are getting for their premium dollars in their health plan.

For many consumers, the 80/20 rule motivated their plans to lower prices or improve their coverage to meet the standard.  This is one of the ways the 80/20 rule is bringing value to consumers for their health care dollars.

For a detailed breakdown of these rebates by state and by market, please visit:http://www.healthcare.gov/law/resources/reports/mlr-rebates06212012a.html


For the text of these proposed notifications, please visit: http://cciio.cms.gov/resources/other/index.html#mlr

For more information on the MLR provision in the Affordable Care Act:http://www.healthcare.gov/law/features/costs/value-for-premium/index.html

For more information on how the Affordable Care Act is creating a transparent market for health insurance, visit:http://www.healthcare.gov/news/factsheets/2010/12/increasing-transparency.html

MAKING PREVENTION WORK IN HEALTHCARE

Photo:  Secretary of HHS Kathleen Sebelius
FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Moving Academic Medicine Forward
June 11, 2012
Baltimore, MD
Johns Hopkins is a terrific place to be talking about the future of medicine.
More than 100 years ago, when Abraham Flexner had to decide which institution to use as his model of medical education, there was little question which it would be. The influence of Johns Hopkins, he wrote, can hardly be overstated. And a century later his words seem truer than ever.

Hopkins has been a leader time and time again: the first major medical school to admit women; the first to use rubber gloves during surgery; the first to develop renal dialysis and CPR. Hopkins helped develop new specialties from neurosurgery and urology to endocrinology and pediatrics.

More recently Hopkins scientists have made discoveries at the foundation of genetic engineering, neurotransmitter pathways, and that most cutting-edge medical technology of all, the checklist.

The last 15 years have been shaped by Dean Miller who came to Johns Hopkins with one of the hardest jobs possible. He was asked to take one of the most renowned medical schools and hospital systems in the world, and make it even better. But that’s exactly what he did.

So Dean Miller, let me add my congratulations to those you’ve received today.
But even here at Johns Hopkins, we must also acknowledge how far we still have to go.
Over the last couple decades there has been a growing consensus about where we need to move our health care system: toward a focus on prevention and maintaining health, a greater emphasis on primary care, more coordination between providers, greater value for dollars spent, and better use of evidence, leading to continuous improvement.

We’re moving in that direction. But I think it’s clear that we’re not moving fast enough. Though we’ve been talking about these reforms for decades in some cases, our health care system is still marked by uneven quality, unequal access, and runaway costs that put care out of reach for far too many families.

And yet, as I speak to you today, I’m very optimistic.
Over the last few years, we’ve seen a number of powerful trends converge: The rapid adoption of electronic health records, a growing public awareness about the importance of prevention, a new eagerness and willingness among providers to embrace change, and the Affordable Care Act – the most important health legislation in over 40 years.

The combination of these trends has created a unique opportunity for progress in health care.  And no one is better positioned to take advantage of that opportunity than Johns Hopkins and America’s teaching hospitals.
Today I want to talk about a few key areas where I believe we have the greatest potential for progress.

The first area is making prevention a priority. There is a growing body of evidence that people’s behaviors outside the health care system – what we eat, how much we exercise, whether we smoke or not – affect our health even more than the treatments and medicines we get when we visit a doctor.
For doctors, this meant experiences like designing the perfect regimen for your patient with diabetes, only to see them go home to a neighborhood where the lack of healthy food options meant their chances of sticking to that diet were almost zero.

So over the last three years, this Administration launched what is probably the most ambitious effort in our country’s history to help people make healthy choices: funding innovative local programs for reducing chronic disease; new laws to make sure kids get healthy school lunches; and historic legislation to make it harder for tobacco companies to market their products to kids -- since we know that every day, 3,800 young people smoke their first cigarette.

We’re also making it easier for doctors to promote good health in their practices.
A key benefit of the health care law is that recommended preventive services like cancer screenings and wellness visits are now available for Medicare beneficiaries and many other Americans at no additional cost.  So doctors no longer have to worry about those patients skipping their mammograms and checkups because they can’t afford the co-pay or deductible.

But prevention only works if leading institutions like Johns Hopkins make it a priority.
That starts in your clinical work where you can give your patients the tools to live healthy lives. Getting a teenager the support he needs to quit smoking may be more important than any test or exam you might provide. And helping a young parent identify asthma triggers in her home may determine whether or not her child truly thrives.

You have a unique role in your patients’ lives, and a powerful opportunity to affect their health well after they leave your offices.

But we also need better research about which community-based prevention programs work and which don’t – especially in areas where we’ve only just gotten started, like childhood obesity. We’ve seen the positive impact of programs like building safe routes to school and smoke-free public housing. But now we need to measure and study their results -- because we know that by honing and improving these interventions, we can reach more people in more communities more effectively.

Another area we’re focusing on is primary care which is fundamental to helping people stay healthy. Yet we face a dire shortage of providers across the country today. As chronic diseases continue to rise and our population continues to age, the need for primary care providers will only grow.

In the Obama Administration, we’re doing our part by increasing reimbursement rates for primary care.  And we’ve added thousands of slots to the National Health Service Corps.  If you go and practice primary care in an underserved community, we’ll help you repay your loans – a win/win.

But we also need academic medicine to further explore the importance of primary care in your research and underscore it in your training. Far too often, especially at our leading teaching hospitals, primary care has been treated like it was less challenging, less important, and a less worthy use of a physician’s skills. We need to change these attitudes, and that starts with our medical schools.

But ultimately, the choice belongs to the next generation of doctors. So, to the medical students here today, I ask you, directly, to consider becoming a primary care physician. If you want to help lead the biggest transformation of medicine in decades, there’s no better place to be.
That brings me to a third area where academic medicine can continue to lead. That is in moving our system toward care coordination.

Thanks to the medical breakthroughs of the last 50 years, millions of Americans today are living with chronic conditions that would have killed them 50 years ago.  It’s good news that we’re living longer.  But it also means we have a new group of patients who often suffer from multiple, chronic conditions.

You may see a patient with congestive heart failure.  But she also has chronic asthma, uncontrolled diabetes, and is a smoker. As she sees more and more individual doctors, the chances that something may fall through the cracks increase. And then, so do the costs of her care.

But we know that doing something right often costs less than doing it wrong. And under the health care law we’re changing the way we pay for care -- to get high value for the dollars we spend.

We’re supporting models like Accountable Care Organizations that will get paid for keeping their patients healthy and not just how many tests and procedures they do. Many of them are led by teaching hospitals, and we need you there going forward on the frontlines of our work to deliver higher value care.

But if we are going to make coordinated care the rule and not the exception, we also need to make sure it’s at the heart of our medical school curricula. There was a time when it was good enough just to train the best specialist in every field. But today, no one person alone can keep their patient healthy. It requires primary care doctors and specialists, but also nurses, community health workers, and substance abuse counselors.

And this multidisciplinary, team-based care, must be part and parcel of training the next generation of physicians. It’s why the surgeon and author Atul Gawande likes to say: today, we need pit crews, not cowboys.

These are three areas where Johns Hopkins can lead the way.  But I also want you to think beyond your own patients, your own students, and your own research grants.    

One of the most important breakthroughs in medicine over the last 10 years was the surgical checklist developed right here at Hopkins. When ICU doctors and nurses implemented the checklist, you saw a real difference.

But what really made the checklist so powerful was when other leaders and other institutions took it up. Michigan hospitals gave it a try and ended up saving 1,500 lives and reduced health care costs by $200 million in just 18 months. Now, hospitals everywhere have embraced it.

So this is the final place I’d like to ask you to step forward. Beyond the three pillars of research, education, and patient care at the heart of academic medicine, we need you to take on another mission. We need you to serve as a model for the future of health care.

Change is hard. People often see the initial advantage of trying something new. But then there are costs and risks involved, and after a few bumps in the road, the temptation is to stick with what you know – even if it’s not working well.

But change becomes easier, if someone creates a path for you to follow. Institutions like Johns Hopkins have always been models for the rest of the nation. But that has been about more than just new facilities or the latest ranking in a particular publication.

It’s also means pushing this country forward, even from the front of the pack, to build a better health care system for all Americans.

I look ahead with great hope for the future of medicine. There will be more obstacles to overcome. But in the face of great challenges, the pioneers of American medicine have never been discouraged. We’re going forward together -- because today, a stronger, healthier America is on the horizon.

U.S. SECRETARY OF HHS KATHLEEN SEBELIUS SPEECH AT WORLD MEDICAL ASSOCIATION IN GENEVA, SWITZERLAND

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
World Medical Association
May 22, 2012
Geneva, Switzerland
Every country in the world recognizes the huge benefits of investing in health. Healthy children are better students. Healthy adults are more productive workers. Healthy families can make greater contributions to their communities. And when we live longer, healthier lives, we have more time to do our jobs, play with our children, and watch our grandchildren grow up.

And yet, in too many countries, including my own, we fall short when it comes to the health of women.

One reason for this is that women are more likely to depend on a male partner to access health care. And they’re often less likely to have the resources they need to get care on their own.

Another obstacle is health systems that too often fail to consider the unique health needs of women.

In the United States, it wasn’t until the 1980s that women were even included in clinical trials. As a result, we had no idea what treatments or medicines were particularly effective for women. We didn’t know what might happen when a drug that had been tested on a 180-pound man, was given to a 110-pound woman.

Despite the progress we’ve made since then, disparities persist to this day. Women in America often pay more for health insurance, just because they’re women. And to add insult to injury, these plans often don’t even cover the basic care they need. In my country, just one out of 8 plans for those who buy their own insurance cover maternity care -- as if getting pregnant were some very rare condition.

The result is that far too many women, who often serve as the health care gatekeepers for their families, go without care themselves.

Of course, we see the same thing around the world. Every two minutes, a woman dies from complications related to pregnancy or childbirth. The risks are even greater if you live in the developing world -- where three out of every four women needing care for complications from pregnancy do not receive it.

Even in places where care is available, the demand is so great that it often stretches resources to their limits.

Last year I visited the maternity ward of the Mnazi Mmoja Hospital in Zanzibar, Tanzania. There were so few beds and nurses that some women had to share beds in the post-natal room. And others were discharged just hours after giving birth. The hospital was doing heroic work. And the women who were able to deliver there, were among the lucky ones. Yet, so much need still went unmet.

We know that when we under-invest in women’s health, whole families pay the price. When a mother dies the chance of her child dying within 12 months, increases seven fold.
So under President Obama, we’re putting a new focus on women’s health – at home and abroad.

In the United States, the key to those efforts is the Affordable Care Act, our most important women’s health legislation in years.
The health care law starts by ending discrimination against pre-existing conditions. Insurers are already prohibited from denying coverage to children because they have asthma or diabetes. And beginning in 2014, all women will be protected from being locked out of the market because they’re a breast cancer survivor, or gave birth by c-section, or were a victim of domestic violence.

In the past -- because they were worried about losing their health coverage -- too many women didn’t have the freedom to make important decisions like changing jobs, starting a new company, even leaving a bad marriage. Now that women know they can’t be turned away because of their health status, we’re taking those choices back from the insurance companies and returning them to the women where they belong.

Next, the law prohibits insurers from charging women more just because they’re women. To put it another way: this means that being a woman is no longer a pre-existing condition.

And the law helps women get the preventive care they need to stay healthy, from mammograms to contraception to an annual check-up where you get to sit down and talk with your doctor, as a basic part of any insurance plan.
These improvements are happening across the lifespan. Young girls now have access to the vaccinations they need stay healthy without their parents worrying about additional costs. And seniors are getting better care to help manage their chronic conditions.
Put all these changes together and they represent the most important and comprehensive American law affecting women’s health in decades.

Now, we’ve also made women and girls a priority for our Global Health Initiative -- a new approach to coordinating the US government’s global health work around the world.
With a focus on collaboration, and innovation, this initiative -- launched by President Obama -- allows us to maximize America’s own strengths and support other nations as they work to improve their people’s health.

We are integrating our programs across the U.S. Government so they can work together more effectively. And we are looking for new and better ways to work with international partners, multilateral organizations, NGOs and foundations to meet our common goals
Through it all, we’ve made women’s health a key priority – and that includes family planning. We know that access to contraception allows women to space their pregnancies and have children during their healthiest years. And delaying pregnancy beyond adolescence can reduce infant mortality and dramatically improve a child’s long-term health. Providing a woman the tools to plan how many children she has, and when she has them, is essential to her health and her family’s health.

Now, just as important is making sure that, when women are pregnant, they get the care and support they need to have a safe and healthy pregnancy and delivery.
The Global Health Initiative’s ‘Saving Mothers Giving Life’ campaign is a great example of these efforts. We know that for mothers and children at risk, the first 24 hours postpartum are the most dangerous. That’s when two out of every three maternal deaths, and almost half of newborn deaths occur.

So we’re working together with groups like Merck for Mothers, the American College of Obstetricians and Gynecologists, Every Mother Counts, and the Government of Norway, to make sure mothers get the essential care they need during labor, delivery, and those crucial first 24 hours, so they can survive and thrive.
We’re focusing on countries with the political will to bring about change. And with more than $90 million in generous support from our non-governmental partners, we have begun selecting pilot sites in the regions of Uganda and Zambia where women are facing some of the highest maternal mortality ratios in the world.

‘Saving Mothers Giving Life’ is just one example. But it illustrates an approach that runs throughout the Global Health Initiative. It starts by identifying the most urgent health challenges affecting some of the world’s poorest nations. Next, we identify the best people in the world with the specific expertise to solve these problems. Then we bring them together, and make sure they have the tools, resources and flexibility to take action.
For too long, too many women and girls have had their lives marred by illness or disability, just because they didn’t have access to health services. When we deprive women of the care and support they need to stay healthy or get well, we’re also robbing them of hope for the future.

That’s the moral argument for making women’s health a priority. But there’s a strategic argument too.

Women are gateways to their communities. Around the world, women are primarily responsible for managing water, nutrition, and household resources. They’re responsible for accessing health services for their families. Many of them are closely involved in actually providing health care for those around them.So by improving the health of women, we can improve the health of communities too.

Consider the story of Jemima, a woman living with HIV in rural western Kenya. At one point, the effects of her HIV got so bad she had wasted to 77 pounds. That’s when a volunteer brought Jemima, her husband, and her sick grandchild to a U.S. government-supported health clinic.

They went home with what is called a “Basic Care Package” – a bundle of low-cost health interventions, developed by public health researchers from our CDC Global AIDS Program to prevent the most debilitating, opportunistic infections among people living with HIV.

Jemima bounced back. She regained a healthy weight. And today she is a health leader in her community. She founded a group that offers emotional support and small loans to families touched by HIV. She sells health products to help support the eight sick and orphaned children she has adopted. And she has referred more than 100 HIV-infected men, women, and children to receive care at the same facility where she got help.
In Jemima, our investment saved not only a life, but a mother, a community leader, an entrepreneur and a health advocate.

What we know from our work with partners around the world is that improving the health of women and girls, unleashes powerful new opportunities – not just for them or their families – but for their communities and countries.

If we want to improve education, we should be giving our young women the healthy start they need to succeed in school. If we want to boost productivity, we can make sure women have access to health care, including family planning and other reproductive health services. If we want to build stronger communities, let’s enable women to teach their neighbors how to prevent disease and stay healthy.

Around the globe, our nations face many challenges. And investing in women’s health is one of the best ways we can address them together.
Thank you.

OBAMA ADMINISTRATION INCREASES BY $100 MILLION FUNDING TO COMBAT ALZHEIMER'S

Photo: Kathleen Sebelius

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HHS Secretary Sebelius outlines research funding, tools for health care providers, awareness campaign and new website

Health and Human Services Secretary Kathleen Sebelius today released an ambitious national plan to fight Alzheimer’s disease. The plan was called for in the National Alzheimer’s Project Act (NAPA), which President Obama signed into law in January 2011. The National Plan to Address Alzheimer’s Disease sets forth five goals, including the development of effective prevention and treatment approaches for Alzheimer’s disease and related dementias by 2025.

In February 2012, the administration announced that it would take immediate action to implement parts of the plan, including making additional funding available in fiscal year 2012 to support research, provider education and public awareness. Today, the Secretary announced additional specific actions, including the funding of two major clinical trials, jumpstarted by the National Institutes of Health’s (NIH) infusion of additional FY 2012 funds directed at Alzheimer’s disease; the development of new high-quality, up-to-date training and information for our nation’s clinicians; and a new public education campaign and website to help families and caregivers find the services and support they need.

To help accelerate this urgent work, the President’s proposed FY 2013 budget provides a $100 million increase for efforts to combat Alzheimer’s disease. These funds will support additional research ($80 million), improve public awareness of the disease ($4.2 million), support provider education programs ($4.0 million), invest in caregiver support ($10.5 million), and improve data collection ($1.3 million).

“These actions are the cornerstones of an historic effort to fight Alzheimer’s disease,” Secretary Sebelius said. “This is a national plan—not a federal one, because reducing the burden of Alzheimer’s will require the active engagement of both the public and private sectors.”

The plan, presented today at the Alzheimer’s Research Summit 2012: Path to Treatment and Prevention, was developed with input from experts in aging and Alzheimer’s disease issues and calls for a comprehensive, collaborative approach across federal, state, private and non-profit organizations. More than 3,600 people or organizations submitted comments on the draft plan.

As many as 5.1 million Americans have Alzheimer’s disease and that number is likely to double in the coming years. At the same time, millions of American families struggle with the physical, emotional and financial costs of caring for a loved one with Alzheimer’s disease.

The initiatives announced today include:

• Research – The funding of new research projects by the NIH will focus on key areas in which emerging technologies and new approaches in clinical testing now allow for a more comprehensive assessment of the disease. This research holds considerable promise for developing new and targeted approaches to prevention and treatment. Specifically, two major clinical trials are being funded. One is a $7.9 million effort to test an insulin nasal spray for treating Alzheimer’s disease. A second study, toward which NIH is contributing $16 million, is the first prevention trial in people at the highest risk for the disease.
• Tools for Clinicians – The Health Resources and Services Administration has awarded $2 million in funding through its geriatric education centers to provide high-quality training for doctors, nurses, and other health care providers on recognizing the signs and symptoms of Alzheimer’s disease and how to manage the disease.
• Easier access to information to support caregivers–HHS’ new website, www.alzheimers.gov, offers resources and support to those facing Alzheimer’s disease and their friends and family. The site is a gateway to reliable, comprehensive information from federal, state, and private organizations on a range of topics. Visitors to the site will find plain language information and tools to identify local resources that can help with the challenges of daily living, emotional needs, and financial issues related to dementia. Video interviews with real family caregivers explain why information is key to successful caregiving, in their own words.
• Awareness campaign – The first new television advertisement encouraging caregivers to seek information at the new website was debuted. This media campaign will be launched this summer, reaching family members and patients in need of information on Alzheimer’s disease.

Today’s announcement demonstrates the Obama administration’s continued commitment to taking action in the fight against Alzheimer’s disease.

In 2013, the National Family Caregiver Support Program will continue to provide essential services to family caregivers, including those helping loved ones with Alzheimer’s disease. This program will enable family caregivers to receive essential respite services, providing them a short break from caregiving duties, along with other essential services, such as counseling, education and support groups.

For more information on the national plan to address Alzheimer’s disease, visit: www.alzheimers.gov.

HHS STATEMENT ON HEPATITIS TESTING DAY

Photo:  Hepatitis B.  Credit:  Wikimedia
FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Statement from HHS Assistant Secretary for Health Dr. Howard Koh
Millions of Americans have chronic viral hepatitis, but up to 75 percent of those infected do not know it.  The U.S. Department of Health and Human Services’ action plan for Combating the Silent Epidemic of Viral Hepatitis designated May 19 as the first-ever National Hepatitis Testing Day.  This day is part of a larger government-wide initiative to educate people about viral hepatitis and to encourage everyone to talk to their health care provider about whether they are at risk.

The prevalence of viral hepatitis in the United States is staggering. Thousands of Americans die every year from hepatitis-related liver disease and liver cancer. There are now lifesaving treatments available that can limit disease progression and prevent cancer deaths.

In order to increase the number of people who get tested for viral hepatitis, the Centers for Disease Control and Prevention has launched a new online Hepatitis Risk Assessment tool, which the Surgeon General and I are promoting through a series of public service announcements.  This online tool will assess an individual’s risk for viral hepatitis and generate a summary of recommendations for testing and vaccination that people can print and take to their doctor to discuss.

Our goal is that this risk assessment tool will raise awareness about this silent epidemic among members of the public, as well as the health care community. We are hoping all of our partners will help us share information about this exciting new tool and encourage people to use it.

SIX STATES WILL RECEIVE $181 MILLION TO IMPLEMENT NEW HEALTH CARE LAW

Photo:  President Obama Signs Heath Care Bill.  Credit:   White House 

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

More states work to implement health care law

Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington receive grants to establish Affordable Insurance Exchanges

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington will receive more than $181 million in grants to help implement the new health care law. The grants will help states establish Affordable Insurance Exchanges.  Starting in 2014, Affordable Insurance Exchanges will help consumers and small businesses in every state to choose a private health insurance plan. These comprehensive health plans will ensure consumers have the same kinds of insurance choices as members of Congress. Including today’s awards, 34 states and the District of Columbia have received Establishment grants to fund their progress toward building Exchanges.

HHS also issued two guidance documents today to help states build Affordable Insurance Exchanges.

“States across the country are implementing the new health care law,” said Secretary Sebelius. “In 2014, consumers in every state will have access to a new marketplace where they will be able to easily purchase affordable insurance.”

Today, the Department released:

• New resources for states: The six new Exchange Establishment grant awards to Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington total more than $181 million. This round of awards brings the total of Exchange-related grants provided to states over the last two years to more than $1 billion.  Illinois, Nevada, Oregon, South Dakota and Tennessee today have been awarded Level One Exchange Establishment grants, which provide one year of funding to states that have begun the process of building their Exchange. Washington is the second state to be awarded a Level Two Establishment grant, which is provided to states that are further along in building their Exchange and offers funding over multiple years.
  In 2010, 49 states and the District of Columbia received Exchange Planning grants totaling more than $54 million; in 2011, seven states received more than $249 million in Early Innovator grants; and to date, 34 states and the District of Columbia have received more than $856 million in Establishment grants.
  States can apply for Exchange grants through the end of 2014, and these funds are available for states to use beyond 2014 as they continue to establish Exchange functionality. This ensures that states have the support and time necessary to build the best Exchange for their residents.
  To see a detailed state-by-state breakdown of grant awards and what each state plans to do with its Exchange funding, visit our new map tool on HealthCare.gov -http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html
• New guidance for states: Today’s guidance includes an Exchange Blueprint states may use to demonstrate how their Affordable Insurance Exchange will work to offer a wide range of competitively priced private health insurance options. The Blueprint also sets forth the application process for states seeking to enter into a Partnership Exchange. If a state chooses to operate its own Exchange or a Partnership Exchange, HHS will review and potentially approve or conditionally approve the Exchange no later than Jan. 1, 2013, so it can begin offering coverage on Jan. 1, 2014.  To see the state Exchange Blueprint, visit http://cciio.cms.gov/resources/other/index.html#hie
• Exchanges in every state: Consumers in every state will have access to coverage through an Affordable Insurance Exchange on Jan. 1, 2014. If a state decides not to operate an Exchange for its residents, HHS will operate a Federally-facilitated Exchange (FFE). This guidance describes how HHS will consult with a variety of stakeholders to implement an FFE, where necessary, how states can partner with HHS to implement selected functions in an FFE, and key policies organized by  Exchange function.
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