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Federal Policy Updates

For state specific policy head to State Policy Updates


Coalition Letter on Promoting Interoperability and Electronic Health Care Information

June 25, 2018

Submitted via www.regulations.gov
Ms. Seema Verma
Administrator
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Re: CMS-1694-P; Request for Information on Promoting Interoperability and Electronic Health Care Information Exchange through Possible Revisions to the CMS Patient Health and Safety Requirements for Hospitals and Other Medicare and Medicaid-Participating Providers and Suppliers

Dear Administrator Verma:

Thank you for the opportunity to provide feedback on your recent Request for Information (RFI) on promoting interoperability and electronic health care information exchange. We appreciate your leadership and commitment to bold action that breaks down barriers to realizing
the full potential of health care data and technology.

Representing many different parts of the health care system, our organizations are united in the belief that we must collaborate in building the infrastructure to share data – the backbone of our collective efforts to improve quality, reduce total cost of care, improve patient experience and finally bring health care into the digital age. We support the proposal to require data sharing related to readmissions, improved care coordination and quality, and a reduction in unnecessary or even dangerous care, as described below, because it represents an important first step in forcing change to a system that has been too slow to evolve in a way that puts the needs of patients first.
We believe that the Administration needs to finalize this proposal, and then keep pushing to unlock the data currently available in the health care system to enable patients and their providers to seamlessly access and share their digital health information.

Today, virtually every entity in the health care system is developing and assembling their own store of patient data. Despite its incredible potential to improve health and health care, the vast majority of this health information is not being used in a way that leverages the ability of data to guide and transform care. The promise of value-based care will not be realized until health care data generated by one provider is shared in a way that unlocks the value for other providers and the patient.

CMS Proposal to Require Information Sharing for Readmissions:
This Administration has a unique opportunity to address the current fragmentation of our health care delivery system by requiring that providers share data to enhance patient care. As you know, an inpatient hospital stay is one of the most significant experiences in a patient’s health care journey – both medically and financially. As we move toward a value-based care system, it is important for a patient’s health care “quarterback” – often a community practitioner – to have realtime, electronic information about major health care incidents so that they recommend and coordinate appropriate follow-up care and help prevent unnecessary downstream health care utilization such as readmissions.

Given the unique health and safety considerations related to an inpatient stay, we support the use of health and safety standards (i.e., Conditions of Participation) to require hospitals to electronically share real-time information with the patient’s community provider(s) when a patient arrives in the emergency department, is admitted or discharged from the hospital or transferred to another facility (ADT alerts). We believe that such action is necessary as federal incentives and penalties (e.g., Meaningful Use, funding for state health information exchange governance and infrastructure) have not resulted in universal hospital adoption of this standard of care.

There is some evidence, however, that tying reimbursement to information exchange requirements results in significantly greater rates of health care data exchange. For example, Maryland’s ability to achieve a 6.5% reduction in hospital admissions was supported by a statewide all-patient all-hospital notification system powered by hospitals’ ADT real-time data. In Maryland, approximately 70% of all Medicare discharges have an associated notification routed to a primary care provider. In Florida, the Agency for Health Care Administration relied on its Low Income Pool authorities to require hospitals to share ADT data, creating a real-time notification network which covers 95% of the acute care hospital beds in the state. In Tennessee, Connecticut, and North Carolina, the state hospital associations have taken the lead and partnered with Medicaid and outside vendors to pursue a real-time notification networks in which all of the hospital association members (and many of their post-acute care partners) will participate. In New York, Statewide Health Information Network for New York (SHIN-NY) has implemented a notification service within and among the 8 RHIOS that serve the state. ADT notification use by providers in New York has been on the rise in recent years, with the network-of-networks reporting a 95 percent jump in ADT notification use from 2016 to 2017.

The same or greater levels of information sharing could be achieved across the country with bold action from CMS. In its RFI, CMS asked for input on using health and safety standards to mandate information sharing in three specific instances: 1) requiring hospitals to electronically transfer medically necessary information to another facility upon patient transfer or discharge; 2) requiring hospitals to electronically send required discharge information to a community provider via electronic means if possible and if a community provider can be identified; and 3) requiring hospitals to make certain information available to patients or a specified third-party application (for example, required discharge instructions via electronic means if requested).

The undersigned organizations support greater information sharing around each of these three use cases and recommend the following.

1. CMS should adopt the following standards requiring hospitals to release ADT data:
• Presentation in Emergency Room/Admissions: The hospital must send real-time electronic notification that a patient has presented in the emergency room and/or been admitted to practitioner(s) responsible for the admitted patient’s care.
• Discharge to Home: The hospital must send real-time electronic notification of discharge to practitioner(s) responsible for the discharged patient’s care. The hospital must also electronically send a copy of the discharge instructions and the discharge summary within 48 hours of the patient’s discharge.
• Transfer of Patients to Another Health Care Facility: The hospital must send necessary medical information to the receiving facility at the time of transfer, and must send a real-time electronic notification of the transfer to the practitioner(s) responsible for the transferred patient’s care.

2. CMS should allow hospitals to meet these conditions over time (for example, by phasing in notification for greater numbers of patients over time) using existing health information exchange networks, private sector partners, or direct connections to community practitioners. Such an approach gives hospitals and community practitioners time to develop the processes and infrastructure necessary to meet such a requirement. Existing community networks are preferred where available.

3. CMS should require hospitals to make certain information electronically available to patients within 24 hours, such as discharge instructions and a summary of care, including through a designated third-party tool of their choice if desired.

We encourage CMS to focus on policy options that are practical and achievable for hospitals without extensive additional work or substantial additional cost. The goal is to create a universal and consistent set of expectations that support patient safety. The pathway we propose aligns with where the market is going, relies on extensively adopted national standards and is consistent with requirements hospitals must already meet through meaningful use and other programs.

CMS Should Finalize this Proposal, and Go Further:
We believe that tying information sharing to Conditions of Participation would be a tremendous benefit to millions of Medicare and Medicaid patients across the country. In addition, we recognize that CMS has other levers that should be used to facilitate greater data sharing and interoperability, including requiring the use of 2015 Edition Certified EHRs and aligning requirements in the Quality Payment Program, the Promoting Interoperability program, and other quality programs such as STAR ratings. In addition to strengthening data sharing requirements in Conditions of Participation, we urge CMS to take additional action to align each of these programs with our national health care data and IT goals.

Conclusion:
Now is the moment for a focused and rigorous effort to liberate the data currently available in the health care system to enable patients and their providers to seamlessly access and share all their digital health information. We believe the time is right to move past the current rigid and siloed system into one prepared to take advantage of all the opportunities made available in our digital age. We thank you again for your leadership and bold action to realize meaningful change.

Sincerely,

Accountable Care Options
Aledade
American Academy of Home Care Medicine
Atlantic ACO
Audacious Inquiry
Beth Israel Deaconess Care Organization
Biden Cancer Initiative
BJC HealthCare ACO
Blue Shield of California
Cambia Health Solutions
Caregiver Action Network
CHESS
Chronic Care Management, Inc.
Coastal Carolina ACO
Community Care Collaborative of Pennsylvania and New Jersey
Delaware Valley ACO
Elation Health
ElevatingHOME/VNAA
Florida Association of ACOs
Healthix
Independent Healthcare Partners
Intel
Iora Health
Kentucky Primary Care Alliance ACO
Keystone ACO
Lancaster General Health Community Care Collaborative
MaineHealth Accountable Care Organization
Manifest MedEx
Mental Health America
Missouri Health Connection
National ACO, LLC
National Association of Accountable Care Organizations
National Association of Mental Illness
National Council for Behavioral Health
National Partnership for Women & Families
NEQCA Accountable Care
New York eHealth Collaborative
North Collaborative Care
Northern Michigan Health Network (NMHN)
OneHealth Nebraska
Patient-Centered Primary Care Collaborative
PatientPing
Quality Independent Physicians ACO
Reliance ACO
Rhode Island Quality Institute
RGV ACO Health Providers, LLC
Saint Francis Healthcare Partners
The Health Collaborative
Tidewater ACO
Triad HealthCare Network
Trillium Health

Guest Commentary: Team-based healthcare offers proven path to improving Americans' mental health

Earlier this year, Cleveland Cavaliers player Kevin Love wrote a powerful piece for the Players' Tribune in which he detailed having his first panic attack, followed by a struggle to seek help. Love was inspired to come forward after Toronto Raptors All-Star DeMar DeRozan tweeted that he had also been grappling with depression.

PCPCC's Comments: Direct Provider Contracting Models - Request for Information

The Patient-Centered Primary Care Collaborative (PCPCC) appreciates this opportunity to provide input on new models with the potential to enhance the patient-clinician relationship and allow providers to innovate to enhance the quality of care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries.  PCPCC is pleased to offer this feedback to the Request for Information, but given the expansive nature of this request, strongly encourages CMS to plan another opportunity for input prior to implementing such a model. 

PCPCC Key Points 
 
PCPCC is pleased to see CMS focused on the challenge of empowering primary care in a value-based environment. We believe there is potential for innovation that strengthens the patient-clinician relationship, provided it is done in a deliberate manner with significant additional guidance. Our key points include:  
 
• CMS must further develop its thinking in this area, focusing this effort on unique opportunities to affect change, then create another opportunity for more detailed feedback and guidance.

• Strong beneficiary protections, dependent on how the model is structured, will be needed – including strong risk adjustment and quality measurement, which needs further investment.   While direct contracting offers new opportunities to engage and empower patients and clinicians, it also comes with significant risks.   

• While PCPCC supports new efforts to engage more providers in value-based care, CMS should avoid changes that might undermine existing programs that are already creating change due to limitations in CMMI’s staff and funding capacity. 
 
 
• Direct contracting in primary care should be an opportunity to increase funding for, and capability of, primary care to address health needs both within and outside of the practice. 

• Cost containment should not be the primary emphasis of a new model, as it will lead to the wrong priorities when designing and launching a model.  Improving quality though a stronger patient-clinician relationship must be the goal.  A primary carefocused model may create cost savings for the health system, but it can take years for this type of transformation to take hold and the savings will not materialize within the scope of a primary care contract.  
 

PCPCC Joins More than 500 Organizations to Oppose CHIP Funding Reduction

May 9, 2018

Dear Member of Congress:

On behalf of 511 national, state, and local organizations dedicated to promoting the health of our nation’s
children and pregnant women, we write to voice our strong opposition to the White House’s proposal to
rescind $7 billion dollars of funding from the Children’s Health Insurance Program (CHIP). This proposal
violates the bipartisan budget agreement that Congress and the President reached earlier this year to set
funding levels for fiscal years 2018 and 2019 and would put children’s access to health insurance
coverage in jeopardy. We urge you to reject the proposal and any attempt to reduce government spending
on the backs of children’s health.

Earlier this year, Congress passed – and the President signed – a law authorizing funding for CHIP for an
additional 10 years. In passing the 10-year extension of CHIP, Congress acted on a bipartisan basis to
provide stability for the program that states, families, and providers sought. The bills signed by President
Trump that extended CHIP for 10 years protect coverage for children, give families peace of mind, and
enable states to make investments that strengthen and improve their CHIP programs. Rescinding such a
substantial sum from CHIP as is contemplated in the rescissions package would undermine the very
program Congress intended to strengthen.

Specifically, the White House is proposing to rescind $15 billion in previously approved spending, almost
half of which would come from two accounts in CHIP, to reduce budget deficits. The proposed cuts
would come from cutting $2 billion from the Child Enrollment Contingency Fund, which provides
payments to states if they experience an unexpected surge in enrollment. The fund ensures that eligible
children can continue to get covered. The White House also proposes to rescind $5 billion from the
Children’s Health Insurance Fund.

While White House officials insist that the CHIP cuts would not harm access to care for children and
families, that is simply not the case. Our nation is facing an increasing number of natural disasters,
including a devastating hurricane season that has displaced thousands of children and families and an
ongoing disaster in Hawaii. Each catastrophe leaves families more vulnerable and more likely to qualify
for CHIP. In addition to natural disasters, the Child Enrollment Contingency Fund provides states needed
protection and security should their CHIP enrollment suddenly spike due to an economic recession or a
public health crisis.

The nine million children and families who depend on CHIP have already faced months of uncertainty,
when its funding expired before Congress took long-overdue action to extend CHIP funding for ten years.
After breathing a short sigh of relief, however, the long-term stability and protection these families fought
to ensure is once again in jeopardy. Our organizations urge you to protect children and families, and to
reject any proposed cuts to the Children’s Health Insurance Program.

Sincerely,

1,000 Days
AASA, The School Superintendents Association
Academy of Nutrition and Dietetics
The Actors Fund
ADAP Advocacy Association
AFL-CIO
African American Health Alliance
AFSCME
Afterschool Alliance
AIDS Alliance for Women, Infants, Children, Youth & Families
AIDS United
Alliance for Strong Families and Communities
America’s Essential Hospitals
American Academy of Pediatrics
American Association of Child & Adolescent Psychiatry
American Association of Colleges for Teacher Education
American Association of People with Disabilities
American Association on Health & Disability
American College of Obstetricians and Gynecologists
American College of Physicians
American College of Surgeons
American Dance Therapy Association
American Dental Hygienists' Association
American Heart Association
American Lung Association
American Muslim Health Professionals
American Network of Oral Health Coalitions
American Nurses Association
American Osteopathic Association
American Pediatric Association
American Pediatric Society
American Psychiatric Association
American Psychological Association
American Public Health Association
American Speech-Language-Hearing Association
American Thoracic Society
The Arc of the United States
Asian & Pacific Islander American Health Forum
Association for Community Affiliated Plans
Association of Asian Pacific Community Health Organizations
Association of Maternal & Child Health Programs
Association of Medical School Pediatric Department Chairs
Association of Nurses in AIDS Care
Association of School Business Officials International
Association of State and Territorial Dental Directors
Association of University Centers on Disabilities
Bazelon Center for Mental Health Law
Blythedale Children's Hospital
CAEAR Coalition
Cancer Support Community
Center for Autism and Related Disorders
Center for Law and Social Policy (CLASP)
Center for Medicare Advocacy
Center for Public Interest Law
Center for Public Representation
Center for the Study of Social Policy
CenterLink: The Community of LGBT Centers
Child Care Aware of America
Child Welfare League of America
Children’s Advocacy Institute
Children's Cause for Cancer Advocacy
Children's Defense Fund
Children's Dental Health Project
Children's Health Fund
Children's Home Society of America
Children's Hospital Association
Children's Leadership Council
Children's Mental Health Network
The Children's Partnership
Circle of Parents, Inc.
Clearinghouse on Women's Issues
Coalition for Health Funding
Coalition on Human Needs
Collaborative for Academic, Social and Emotional Learning
Committee for Children
Community Access National Network (CANN)
Community Catalyst
Council for Exceptional Children
Council of Administrators of Special Education
Cystic Fibrosis Foundation
Drug Policy Alliance
Easterseals
El Centro del Inmigrante
End AIDS Now
Epilepsy Foundation
Every Child Matters
Families USA
Family Focused Treatment Association
Family Voices
Feminist Majority
First Focus Campaign for Children
Forum for Youth Investment
Futures Without Violence
Health Care for America Now
HIV Medicine Association
In Our Own Voice: National Black Women's Reproductive Justice Agenda
International Union, United Automobile, Aerospace, and Agricultural Implement Workers of America
UAW
The Jewish Federations of North America
Jon C Burr Foundation
Justice in Aging
Lakeshore Foundation
Learning Disabilities Association of America
Legal Action Center
March of Dimes
Mi Familia Vota
MomsRising
MSDA
NAACP
National Alliance of State & Territorial AIDS Directors
National Alliance on Mental Illness
National Alliance to Advance Adolescent Health
National Association for Children's Behavioral Health
National Association of Community Health Centers, Inc.
National Association of County and City Health Officials
National Association of County Behavioral Health & Developmental Disability Directors
National Association of Pediatric Nurse Practitioners
National Association of School Nurses
National Association of School Psychologists
National Association of Secondary School Principals
National Association of State Directors of Special Education
National Coalition for Cancer Survivorship
National Coalition on Health Care
National Consumers League
National Council for Behavioral Health
National Council of Jewish Women
National Education Association
National Health Law Program
National Hispanic Medical Association
National Immigration Law Center
National Partnership for Women & Families
National Patient Advocate Foundation
National Physicians Alliance
National Recreation and Park Association
National Respite Coalition
National WIC Association
National Women's Health Network
National Women's Law Center
Nemours Children's Health System
NETWORK Lobby for Catholic Social Justice
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Nurse-Family Partnership
Oral Health America
Partnership for America’s Children
Patient-Centered Primary Care Collaborative
Pediatric Infectious Diseases Society
Pediatric Policy Council
Planned Parenthood Federation of America
Public Advocacy for Kids
Public Citizen
Racial and Ethnic Health Disparities Coalition
Raising Women's Voices for the Health Care We Need
Religious Institute
Sargent Shriver National Center on Poverty Law
School Social Work Association of America
School-Based Health Alliance
Service Employees International Union (SEIU)
Sexuality Information and Education Council of the United States (SIECUS)
Society for Pediatric Research
Society for Public Health Education
Southern HIV/AIDS Strategy initiative
Treatment Action Group
Trust for America’s Health
UnidosUS
Union for Reform Judaism
United Methodist Church - General Board of Church and Society
United Methodist Women
United Way Worldwide
W. Haywood Burns Institute
Wolfson Children’s Hospital
Young Invincibles
YWCA USA
ZERO TO THREE
STATE, TERRITORY AND LOCAL ORGANIZATIONS
Alabama
AIDS Alabama
Voices For Alabama's Children
Alaska
Alaska Children’s Trust
Arizona
Mi Familia Vota
Native American Connections
Raising Special Kids
Arkansas
Office of Oral Health Arkansas Department of Health
California
Alameda Health Consortium
American Academy of Pediatrics, California
Asian Americans Advancing Justice - Los Angeles
California Children's Hospital Association
California Dental Association
California Medical Association
California Pan-Ethnic Health Network
California School Nurses Organization
California School-Based Health Alliance
California WIC Association
CaliforniaHealth+ Advocates
Children Now
Children's Defense Fund - California
Children's Hospital Los Angeles
Coalition for Humane Immigrant Rights (CHIRLA)
Community Health Councils
Cope Family Center
County Health Executives Association of California
El Concilio
Family Voices of California
Family Voices of California
First 5 Napa County
First 5 Santa Cruz County
Give for a Smile
Health Access California
Healthier Kids Foundation
Inland Empire Coverage & Health Initiative
Lucile Packard Children's Hospital Stanford/Stanford Children's Health
PDI Surgery Center
Regional Asthma Management & Prevention
Results California
RESULTS Sacramento Delta Area
RESULTS San Francisco
San Francisco AIDS Foundation
Services, Immigrant Rights, and Education Network (SIREN)
Street Level Health Project
The Los Angeles Trust for Children's Health
United Ways of California
Colorado
Center for Health Progress
Children's Hospital Colorado
Colorado Association for School-Based Health Care
Colorado Behavioral Healthcare Council
Colorado Center on Law and Policy
Colorado Children's Campaign
Colorado Consumer Health Initiative
Colorado School Medicaid Consortium
Colorado's Community Safety Net Clinics
Delta Dental of Colorado
Denver Health and Hospital Authority
Every Child Pediatrics
Gary Community Investments
Oral Health Colorado
RESULTS Colorado
Stahlman Disability Consulting, LLC
Support Jeffco Kids
Tri-County Health Department
Connecticut
Connecticut Association for Human Services
Connecticut Voices for Children
Florida
Hope and Help Center of Central Florida, Inc.
Oral Health Florida
The Children’s Campaign
Voices for Florida
Georgia
Children's Healthcare of Atlanta
Georgia Watch
Georgians for a Healthy Future
Voices for Georgia's Children
Hawaii
Hawaii Children’s Action Network
Idaho
Idaho Voices for Children
Illinois
Ann and Robert H. Lurie Children’s Hospital of Chicago
Citizen Action/Illinois
EverThrive Illinois
DuPage Federation on Human Services Reform
Family Voices of Illinois
Health Justice Project, Beazley Institute for Health Law and Policy, Loyola University Chicago School of
Law
Indivisible - Randolph County
Indivisible Illinois
Indivisible Peoria Area
Indivisible Wrigleyville
Illinois Chapter, American Academy of Pediatrics
Legal Council for Health Justice
Voices for Illinois Children
Iowa
Child and Family Policy Center
Kansas
Alliance for a Healthy Kansas
Kansas Action for Children
Kansas Appleseed
Kansas Association of Community Action Programs
KS Head Start Association
Oral Health Kansas
United Community Services of Johnson County
Kentucky
Conover & Conover CPAs, PSC
Kentucky Voices for Health
Kentucky Youth Advocates
Louisiana
504HealthNet
Agenda for Children
Louisiana Budget Project
Louisiana Partnership for Children and Families
Maine
Maine Children's Alliance
Maine Equal Justice Partners
Maine People's Alliance
Maryland
Maryland Citizens' Health Initiative Education Fund, Inc.
Maryland Dental Action Coalition
Massachusetts
Association for Behavioral Healthcare
Children's League of Massachusetts
Children's Mental Health Campaign
Franciscan Children's
Health Care For All
Health Law Advocates
Massachusetts Association for Mental Health
Massachusetts Dental Hygienists’ Association
Massachusetts Law Reform Institute
Massachusetts Pediatric Home Nursing Campaign
RESULTS Greater Boston
The Forsyth Institute
Michigan
HIV AIDS Alliance of Michigan
JHM Consulting, LLC
Kent County Oral Health Coalition
Lansing Area AIDS Network
Michigan Association of Intermediate School Superintendents
Michigan Association of School Boards
Michigan Association of School Superintendents
Michigan League for Public Policy
Michigan Oral Health Coalition
Middle Cities Education Association
New Covnant of Peace Church
Northern Michigan Oral Health Coalition
RESULTS Ann Arbor
RESULTS Detroit
The MAN Network
United Health Organization
Minnesota
Apple Tree Dental
Mississippi
Ascension Lutheran Church
Coalition for Citizens with Disabilities
Mississippi Center for Justice
Mississippi Human Services Coalition
Mississippi Rising Coalition
National Alliance on Mental Illness - Mississippi
Missouri
Kids Win Missouri
RESULTS Kansas City
Montana
Montana KIDS COUNT
RESULTS Missoula
Nebraska
Voices for Children in Nebraska
Nevada
Children's Advocacy Alliance
Community Health Alliance
Foundation for Positively Kids
Immunize Nevada
Indivisible Northern Nevada
Nevada Alliance for Healthcare Security
Women’s March Reno
New Hampshire
New Hampshire Family Voices
New Hampshire Oral Health Coalition
New Jersey
Advocates for Children of New Jersey
Family Voices New Jersey
First Children Services
New Jersey Association of Mental Health and Addiction Agencies, Inc.
New Jersey Citizen Action
New Jersey Oral Health Coalition
SPAN Parent Advocacy Network
New Mexico
Equality New Mexico
New Mexico Voices for Children
New York
Action Together Long Island
Adhikaar
Association of Perinatal Networks
Buffalo Prenatal Perinatal Network
Center for Independence of the Disabled, NY
Children's Defense Fund - New York
Chinatown Manpower Project
Chinese-American Planning Council
Citizen Action of NY
Citizens' Committee for Children of New York
Coalition for Asian American Children and Families
Community Service Society of New York
Fiscal Policy Institute
Health Care For All New York
Healthy Capital District Initiative
Healthy Community Alliance
Hunger Action Network of New York State
Korean Community Services of Metropolitan NY
Long Island Activists
Long Island Progressive Coalition
Lower Hudson Valley Perinatal Network
Make the Road New York
Medicaid Matters NY
Mekong NYC
Mental Health Association in New York State, Inc.
Metro New York Health Care for All
Nassau-Suffolk Hospital Council
New York Immigration Coalition
New York School-Based Health Alliance
New York School-Based Health Foundation
New York State Council of Churches
New York University
North Country Prenatal/Perinatal Council, Inc.
Public Health Solutions
Schuyler Center for Analysis and Advocacy
Show Up Long Island
South Asian Council for Social Services
South Asian Youth Action
Staten Island Alliance for North Shore Children and Families
Suffolk Progressives
TSD Media
Westchester Children's Association
Womankind
Yeled V’Yalda E.C.C
North Carolina
Advocates for Medically Fragile Kids NC
Equality North Carolina
NC Child
RESULTS-Asheville NC
North Dakota
Ehrens Consulting
Family Voices of ND
Ohio
Akron Children's Hospital
Children's Defense Fund-Ohio
Cincinnati Children's Hospital Medical Center
CWRU Schubert Center for Child Studies
Dayton Children's Hospital
Harmony Project
Juvenile Justice Coalition (OH)
Merrick House Neighborhood Center
Nationwide Children's Hospital
Ohio Association of Child Caring Agencies
Ohio Children's Hospital Association
Ohio Federation of Teachers
PCSAO
Policy Matters Ohio
Public Children Services Association of Ohio
RESULTS Ohio
Universal Health Care Action Network of Ohio
Voices for Ohio's Children
Oklahoma
Oklahoma Chapter of the American Academy of Pediatrics
Oklahoma Institute for Child Advocacy
Oregon
Children First for Oregon
RESULTS Corvallis
Pennsylvania
Pennsylvania Partnerships for Children
Public Citizens for Children and Youth
RCPA
Rhode Island
Rhode Island KIDS COUNT
South Carolina
Palmetto Project, Inc.
SC Appleseed Legal Justice Center
United Way of the Midlands
Tennessee
Niswonger Children's Hospital
Tennessee Commission on Children and Youth
Tennessee Health Care Campaign
Tennessee Justice Center
Texas
Center for Public Policy Priorities
Children's Defense Fund – Texas
Children's Hospital Association of Texas
Clarity Child Guidance Center
Coalition of Texans with Disabilities
CommuniCare Health Centers
Driscoll Health Plan
Easterseals Central Texas
Easterseals Greater Houston
Easterseals North Texas
Easterseals Rio Grande Valley
Equality Texas
Healthy Futures of Texas
La Frontera Ministries International Inc.
Methodist Healthcare Ministries of South Texas, Inc.
Methodist Healthcare System - San Antonio
National Association of Social Workers - Texas Chapter
Our Medicaid Matters
Personal Attendant Coalition of Texas
Proyecto Azteca
RESULTS Austin
RESULTS Houston US Poverty
Texas AFL-CIO
Texas Children’s Hospital
Texas Doctors for Social Responsibility
Texas Parent to Parent
Texas Pediatric Society
The Center for Health Care Services
The Health Collaborative
TX Occupational Therapy Assoc
United Ways of Texas
Voices for Children of San Antonio
Women's March of Houston and Texas
Utah
RESULTS Utah
Utah County Department of Drug and Alcohol Prevention and Treatment
Utah Health Policy Project
Voices for Utah Children
Vermont
Dental Health
Vermont Family Network
Voices for Vermont's Children
Virginia
Champions For Children: Prevent Child Abuse Hampton Roads
Child Health Investment Partnership
Families Forward Virginia
Family and Children's Trust Fund of VA
Family Lifeline
Healthy Families Northern Shenandoah Valley
National Alliance on Mental Illness of Virginia
Piedmont Regional Dental Clinic
The Improvement Association
Virginia Poverty Law Center
Voices for Virginia's Children
Washington
Parent Trust for Washington Children
RESULTS Bremerton
RESULTS Olympia
RESULTS Seattle
13
RESULTS Tri-Cities
Seattle Children's
West Virginia
Children's Home Society of West Virginia
Partners in Community Outreach
West Virginia Center on Budget and Policy
West Virginia Kids' Health Partnership
West Virginia Medicaid Coalition
West Virginians for Affordable Health Care
West Virginians Together for Medicaid
Wisconsin
Children's Hospital of Wisconsin
Kids Forward
Milwaukee Area Health Education Center
Wisconsin Hospital Association
Wyoming
UPLIFT

PCPCC Signs Letter Urging Rapid Action to Stabilize Health Insurance Markets

Dear Speaker Ryan, Leader McCarthy, Leader Pelosi, Senator McConnell and Senator Schumer: 

We write to urge rapid, bipartisan action to stabilize the nation’s health insurance markets and prevent cost increases for American families. The undersigned organizations are associations of large and small employers, consumer and patient advocacy groups, health plans, health systems, advocates for health quality and safety, faith groups, associations representing physicians, nurses, pharmacists and other health professionals, pension funds, and labor unions. 
 
The nation’s individual health insurance markets are facing growing challenges. The past year has brought destabilizing uncertainty that has driven up premiums and cost-sharing across the country. Premiums climbed by 17% in 2017, according to the Kaiser Family Foundation. The average silver plan deductible has reached $4034. The recently enacted elimination of individual mandate penalties could accelerate these trends. 
 
These circumstances require an immediate response. We call on Congress to enact legislation, built around robust federal funding for reinsurance that is adequate to ensure stability, encourage competition and lower costs for consumers while maintaining the core consumer protections in current federal statute. Reinsurance provisions of this legislation should be structured in a manner to bring relief to consumers in every state. To assure its sustainability, any legislative solution must be bipartisan. 
 
On behalf of the 17 million Americans who depend on individually purchased health insurance for their health security, we appeal to you to demonstrate the leadership this moment requires. With rate filings for health plans participating in the Marketplaces due next month, the time for further debate has expired. The time for action is now. 
 

Healthcare Coalition Calls on CMS to Maintain Leadership on Value-Based Payment

WASHINGTON –  The Patient-Centered Primary Care Collaborative (PCPCC) this week called on the Centers for Medicare and Medicaid Services (CMS) to maintain progress on its efforts to drive the shift to value, while empowering beneficiaries through the support of reliable access to primary care. 

“We are encouraged by the ideas outlined by CMS and urge the agency to use this opportunity to allay stakeholder concerns about the possibility of slowing government leadership in the transition to outcome-based payment,” said Ann Greiner, President and CEO of the Patient-Centered Primary Care Collaborative.  “By setting forth and maintaining a vision for high-value care, CMS can continue to incent change and expand participation in both the public and private sector.”

Ms. Greiner said that the PCPCC supports CMS efforts to leverage payment models from other public and private programs and assign credit to clinicians and other providers participating in value-based models wherever due.  They also encourage CMS to actively work toward an environment in which the administrative burden on clinicians and other providers participating in value-based payment is both manageable and consistent across all public and commercial payment programs.

PCPCC encouraged CMS to continue its focus on the long-range vision of what our healthcare system should be and what individual steps are needed to achieve that vision.  This ongoing vision is critical to ensure continuity and stability in the approaches taken by the Innovation Center, as this continued leadership toward a defined goal is essential to health system transformation.

PCPCC also encouraged an emphasis on ensuring every American has access to primary care physicians and other clinicians in their community, that healthcare providers engage in coordinated team-based care and preventative and population-based health, that patients are engaged and active participants in their health and well-being and that payment emphasize value – not volume in healthcare delivery.

Please find the full comments of the PCPCC below.

PCPCC Statement: Graham-Cassidy Health Care Bill

WASHINGTON — The Patient-Centered Primary Care Collaborative (PCPCC) advocates for high quality, affordable, and patient-centered primary care for all. We have evaluated the proposed changes to the health care legislation against these goals.

Several provisions contained in the Senate bill, crafted by Senators Bill Cassidy, Lindsey Graham, and Dean Heller, are problematic for advancing primary care and do not appear to align with the PCPCC mission. More specifically:

  • Allowing states to change what qualifies as an essential health benefit could disrupt access to health care services for millions of Americans, erode affordability, and hinder patient access to much needed health care services.
  • Penalizing states that expanded Medicaid -- by having the federal government pay the states a smaller portion of the cost -- will likely lead to reduced coverage for primary care in those states and harm vulnerable patients.
  • Enabling states to have broad flexibility to use funds through block grants could allow states to waive important existing requirements that protect patients, such as prohibiting higher premiums for those with pre-existing conditions.
  • Eliminating the individual mandate on the federal level will likely result in fewer individuals enrolled in the Exchanges and encourage healthy people to exit the market. This would likely lead to much higher costs for those that remain.  Research shows that when patients are faced with higher cost sharing, they forego essential care, especially primary and preventive care.  

This bill would negatively disrupt the Medicaid program, increase out-of-pocket costs, and financially burden Americans. In addition, this bill has the potential to harm those living with pre-existing conditions. We continue to be committed to working with Congress on modifying health care legislation that expands access to primary care while reducing cost. 

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About the Patient-Centered Primary Care Collaborative

Founded in 2006, the PCPCC is a not-for-profit membership organization dedicated to advancing an effective and efficient health care system built on a strong foundation of primary care and the patient-centered medical home (PCMH). The PCPCC achieves its mission through the work of its executive members, experts, thought leaders, and other stakeholders focused on key issues of delivery reform, payment reform, patient engagement, and benefit design to drive health system transformation. For more information or to become an executive member, visit www.pcpcc.org.

PCPCC Statement on Draft Senate Health Care Bill

The Patient-Centered Primary Care Collaborative (PCPCC) advocates for high quality, affordable and patient-centered primary care for all.  We evaluate proposed changes to healthcare legislation against these goals.

Several provisions contained in the draft Senate bill do not appear to align with these aims. More specifically:

  • Capping of Medicaid payments and reductions in exchange subsidies will likely lead to reduced coverage for primary care and prevention among other services.
  • Allowing for more state flexibility as it relates to essential benefits could erode affordability and patient access to needed services, including screenings, maternity care, mental health services and more.
  • Getting rid of the individual mandate without an adequate replacement strategy will likely lead to fewer individuals enrolled in the exchanges and much higher costs for those who choose to continue with coverage because of their health needs. Research has demonstrated that when patients are faced with higher cost sharing, they forego care, especially primary and preventive care.

We are committed to continuing to work with Congress on changes to health care legislation that expand access to high performing primary care that is proven to improve overall quality and to reduce costs. We urge Congress to support this positive pathway as a priority for the health care system. 

 

National Multi-Stakeholder Coalition of More Than 70 Organizations Emphasizes the Need to Advance Primary Care

WASHINGTON — As Congress explores changes to the health care system, the Patient-Centered Primary Care Collaborative (The Collaborative) emphasizes the need to continue to advance coverage of primary care and to align payment reform for primary care as essential to achieving better health outcomes and lower costs.

The Collaborative is a not-for-profit multi-stakeholder membership organization representing more than 70 organizations – public and private – including payers, health care providers, leading corporations and patient and consumer advocacy groups.  We are committed to promoting policies and sharing best practices that support growth of high-performing primary care to achieve the “Quadruple Aim:” better care, better health, lower costs, and greater joy for patients, clinicians, and staff in delivery of care.

Advanced primary care is foundational to delivery system transformation, and patient-centered medical home initiatives continue to reduce health costs and unnecessary utilization of services (PCMH Evidence Report 2016).

The Collaborative strongly urges Congress to ensure that:

  • Americans have access to affordable coverage for primary care services, without which the health of individuals, families and their communities will be threatened.

"According to The Commonwealth Fund, patients who have a primary care physician have 33 percent lower health care costs, and live longer, healthier lives." (Source: The Commonwealth Fund, "Health Reform & You - Primary Care: Our First Line of Defense." 12 June 2013.)

  • Payment reform – innovative alternate payment models – continue to be advanced, in both the public and private sectors (including Medicare and Medicaid) to encourage and support primary care.

According to the National Coalition on Health Care, “New payment models and dedicated efforts to coordinate care are changing the delivery of health care, but more progress needs to be made.”

Much progress has been made over the past decade to transform primary care, to develop benefit designs that support and reward advanced primary care through the patient-centered medical home, to encourage patient and family engagement and to develop and implement alternative payment systems.  These efforts have resulted in better health and lower costs. Congress must continue to support this positive path as a priority for the health care system.

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About the Patient-Centered Primary Care Collaborative (PCPCC)
Founded in 2006, the PCPCC is a not-for-profit multi-stakeholder membership organization dedicated to advancing an effective and efficient health care system built on the strong foundation of primary care and the patient-centered medical home (PCMH). Membership includes a broad group of public and private organizations, including payers, providers, patient and consumer advocacy groups, non-profits and leading corporations dedicated to transforming health care. The PCPCC achieves its mission through the combined work of its executive members, Stakeholder Centers, clinicians and thought leaders focused on the key issues of delivery reform, payment reform, and patient engagement, to drive health system transformation. For more information, or to become an executive member, visit www.pcpcc.org.

Open Letter to the President-Elect's Transition Team

The Patient-Centered Primary Care Collaborative (PCPCC) looks forward to working with the new Administration to enhance access to and the quality of primary care, to continue the expansion of the patient-centered medical home, and to advance the bipartisan work on value-based alternative payment models, especially those which result in a greater investment in primary care.

PCPCC is a collaborative health care policy organization, made up of a broad coalition of approximately 1,300 organizational members and dozens of executive members (from across the spectrum of primary care: payers, purchasers, health care providers and consumers).

Our mission is to better promote and share best practices that support the growth of high-performing primary care, with the ultimate goal being the “quadruple aim”: better care, better health, lower costs, and greater joy for clinicians and staff in care delivery. We educate and advocate for ideas, concepts, policies, and programs that advance these goals and the standards of high-performing primary care. 

For the decade since it was formed, PCPCC has advocated a vision of an effective and efficient U.S. health system built on a strong foundation of primary care and the patient-centered medical home (PCMH). A medical home, defined as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety provides enhanced primary care services of value to patients, their families, and the care teams who work with them.

This evolving model promises improved access to high-quality, patient-centered primary care by prioritizing trusted relationships with patients, families, and caregivers; incorporating team-based care with clinicians and staff working at the top of their skill set; and providing cost-effective care coordination and population health management. 

We at PCPCC look forward to serving as a resource for your Administration regarding the current and future state of primary care and patient-centered medical homes in this country. 

Sincerely,

Rosemarie Sweeney, MPA
Interim CEO, Patient-Centered Primary Care Collaborative

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