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Letter to Marilyn Tavenner -Continue Cost-Saving Program


Location: Washington, DC

A bipartisan group of Pennsylvania lawmakers joined Sen. Pat Toomey (R-Pa.) today in urging Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), Marilyn Tavenner, to extend and expand the Medicare Coordinated Care Demonstration (MCCD) Project, a program which has yielded Medicare savings. Sen. Bob Casey (D-Pa.) and Reps. Mike Fitzpatrick (R-Pa.) and Allyson Schwartz (D-Pa.) signed onto Sen. Toomey's letter asking the Acting Administrator to reevaluate terminating the MCCD, pointing to the success of a Pennsylvania-based program that has resulted in strong patient satisfaction and cost savings.

Health Quality Partners (HQP), a non-profit research and development organization based in Doylestown, PA, secured one of 15 original grants in 2001. However, these competitive grants are slated to expire on June 30, 2013. HQP's program sends nurse care managers into a patient's home to provide in-person coordinated care.

According to a March of 2011 report by Mathematica Policy Research, HQP's efforts reduced Medicare costs for a subset of high-risk enrollees by 28 percent. These savings have been achieved as a result of HQP's proactive approach to care and early identification of emerging problems for patients which has led to decreased hospital visits.

Ruth Goldschlager, an HQP patient and resident of Chalfont, PA said: "Health Quality Partners has become an important part of my life and I owe the better parts of my good health to them. Before HQP entered my life, I was in the emergency room often, but now my nurse checks in on me once a month and I can't remember the last time I visited the ER. I'm 83 years old and because of HQP, I feel healthy and have learned what it takes to be healthy."

James L. Brexler, President and CEO of Doylestown Hospital said: "Doylestown Hospital has been proud to collaborate with Health Quality Partners from the start of its MCCD. The evidence clearly suggests that HQP's chronic care model not only helps providers meet financial goals, but also offers superior medical and psychosocial support to patients and their families. The HQP model has proven to be highly successful especially for patients with complex medical and social conditions. As hospitals and doctors implement innovative systems, there remain more lessons to be learned. We now need to test these models on larger populations and replicate these successes in other communities."

"I am highly encouraged with the results Health Quality Partners has had in reducing Medicare costs and delivering quality health care to seniors in Pennsylvania," said Sen. Toomey. "HQP's approach personalizes care with a good-old-fashioned house call. These techniques are not only saving money but improving the quality of life for those afflicted with chronic illnesses. I urge Administrator Tavenner to take a look at Health Quality Partners' success and extend the demonstration project so that entities which exhibit reduced expenditures for Medicare are able to participate and provide quality care to beneficiaries."

Health Quality Partners in Doylestown has demonstrated how to reduce healthcare costs while improving quality," Senator Casey said. "The program has saved taxpayers and consumer's money, while improving the health of the people it serves, and I'm urging the Administration to allow it to continue."

"The results achieved by Health Quality Partners over the last decade demonstrate that it is indeed possible to increase the quality of patient care while decreasing costs for seniors and taxpayers," said Rep. Allyson Schwartz. "It is time for the federal government to set Medicare on a path toward payment and delivery models that offer providers flexibility and ensure that millions of Medicare beneficiaries will continue to have access to their doctors. HQP is an example of what works in health care and we should not only continue to support this effort, but also replicate this successful model in other communities and across the nation."

"With this program working right here in my district, I voiced my concerns to CMS earlier this year and I am pleased to see my colleagues join the effort," said Rep. Mike Fitzpatrick. "With taxpayer dollars at a premium, we should be encouraging pilot programs like this which have promising results and save money. I urge CMS to support an extension, and scale up, of the program to ensure that the federal resources being poured into Medicare are resulting in the best care and the most efficient service."

The full letter to CMS is provided below:

May 10, 2013

Marilyn Tavenner
Acting Administrator
Centers for Medicare & Medicaid Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Ms. Tavenner:

We are writing to express our concern with the imminent termination of the Medicare Coordinated Care Demonstration (MCCD) Project.

The Balanced Budget Act of 1997 (BBA) established the MCCD Project to evaluate care coordination programs in the Medicare fee-for-service (FFS) setting. In 2001, the Centers for Medicare & Medicaid Services (CMS) granted competitive awards to 15 demonstration programs and subsequently provided three extensions, allowing the demonstration program to continue through June 30, 2013.

Health Quality Partners (HQP), a non-profit R&D organization based in Doylestown, PA, secured an original grant in 2001 and continues to participate in the MCCD, providing community-based and data-driven coordinated care delivered by nurse care managers. In March of 2011, Mathematica Policy Research provided its fourth evaluation of the MCCD to Congress and concluded that HQP's efforts successfully reduced Medicare's monthly expenditures for a subset of high-risk enrollees by 28 percent while also producing strong levels of beneficiary and provider satisfaction. Medicare achieved these savings as a result of HQP's data-driven approach to patient management that sends care coordinators into the community to help patients manage complex care needs across care settings and by closely monitoring patients for early identification of emerging problems for proactive interventions. Over the last decade, the MCCD has yielded important lessons and innovative approaches to patient care. Despite these positive results, CMS is on track to terminate the MCCD Project on June 30, 2013.

In Mathematica's third report to Congress they wrote, "failing to pursue effective programs such as Health Quality Partners or QMed (and possibly Mercy Medical Center) may mean a missed opportunity to substantially improve the quality of care for chronically ill beneficiaries at no increase in cost to Medicare...Furthermore, the benefit of identifying successful interventions could be great for Medicaid as well, as nearly all states are investing in disease management programs, typically with little or no evidence that the programs will generate the savings that commercial programs promise. Thus, honing in on a detailed, concrete description of successful interventions for those with chronic illnesses and testing the replicability of these interventions seems to warrant serious consideration."[1]

The Center for Medicare & Medicaid Innovation's (CMMI) mission is to identify initiatives which improve the quality of care and deliver care efficiently---objectives which the MCCD has already proven with independently verified results. Section 4016 of the BBA provides the Secretary with the authority to expand the demonstration project and indicates that the Secretary, "may issue regulations to implement, on a permanent basis, the components of the demonstration project that are beneficial to the Medicare program."[2] In light of CMS' objectives and statutory authority, we ask that you consider extending and expanding MCCD, allowing entities who can demonstrate reduced expenditures for Medicare to provide quality care to beneficiaries. Terminating a program with high beneficiary satisfaction and proven Medicare savings appears counter-productive to federal efforts to put Medicare on a sustainable path.

We appreciate your consideration and look forward to your timely response.


_____________________ _____________________

Pat Toomey Robert P. Casey, Jr.

U.S. Senator U.S. Senator

_____________________ _____________________

Allyson Y. Schwartz Michael G. Fitzpatrick

Member of Congress Member of Congress

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