Key lawmakers on Capitol Hill are committed to advancing significant reforms to Medicare payment policy and care delivery structure during the 114th Congress. With the presidential elections looming in November 2016, the next 12 months represent the likely window for this process to develop.
ACCP is engaged in an ongoing dialogue with several congressional offices to identify opportunities for incorporating comprehensive medication management (CMM) coverage delivered in a collaborative, team-based manner based on ACCP’s Medicare Initiative policy platform within this broader reform package.
ACCP members should be prepared to engage with their elected officials during the coming months to help ensure the inclusion of a CMM component as part of the legislative package that emerges from this process.
In Depth—Senate Finance Committee Chronic Care Initiative Update
Since the legislation permanently repealing the flawed Medicare SGR (sustainable growth rate) formula was signed into law by President Barack Obama earlier this year, Congress has been moving forward on several key health care initiatives. In June, the House Energy and Commerce Committee approved an initiative called the “21st Century Cures Act.” This act is aimed at accelerating the discovery, development, and delivery of promising new treatments and cures for patients and maintaining America’s standing as the biomedical innovation capital of the world.
Meanwhile, the Senate has turned its attention to a legislative effort aimed at improving the quality of care and outcomes provided to Medicare patients with chronic conditions. Citing staggering statistics, including the fact that treatment of chronic illness accounts for 93% of Medicare spending and that more than two-thirds of Medicare beneficiaries have several chronic conditions, Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) issued a letter to health care stakeholders announcing the formation of a bipartisan congressional working group to begin exploring solutions that will improve outcomes for Medicare patients requiring chronic care.1 This announcement followed a May 15 Senate Finance Committee hearing on the issue.
Response to the committee’s request for input was overwhelming—more than 530 submissions from interested stakeholders across the country provided ideas on ways the Medicare program can better deliver health care to beneficiaries with several chronic conditions. Senate leadership reacted positively to the response from the health care community. In a statement released by Hatch and Wyden, the senators commented:
We appreciate the input from members of the health care community and are thrilled so many weighed in on this important bipartisan issue. We also applaud Senators Johnny Isakson and Mark Warner for their hard work in leading this initiative. Their efforts represent a strong bipartisan desire to find real solutions that provide high quality medical care to Medicare patients, at greater value and lower cost, without adding to the deficit. We look forward to partnering with our colleagues to review the submissions as we work toward a common goal of developing bipartisan legislative solutions this Congress.
ACCP Comments to the Bipartisan Working Group
In response to the request for input, ACCP, together with its Medicare Initiative partner, the College of Psychiatric and Neurologic Pharmacists (CPNP), submitted a joint statement to the committee. The statement addressed several key issue areas outlining specific policy categories the committee plans to consider as part of its chronic care reform efforts:
- Ideas to effectively use or improve the use of telehealth and remote monitoring technology
- Strategies to increase chronic care coordination in rural and frontier areas
- Ways to address the effective use, coordination, and cost of prescription drugs
- Ways to more effectively use primary care providers in order to meet the goal of maximizing health care outcomes for Medicare patients living with chronic conditions
In the comment letter, ACCP and CPNP urged the committee to focus on care delivery models that promote and incentivize a truly patient-centered and interprofessional approach to medication-related clinical care and medication safety. ACCP and CPNP called on the committee to advance a quality-focused, patient-centered, team-based approach to health care delivery that helps ensure the safety of medication use by patients and that achieves the medication-related outcomes aligned with patients’ overall care plans and goals of therapy through the provision of CMM.
ACCP and CPNP urged Congress to enact reforms to the Medicare program that allow for coverage of CMM services provided by qualified clinical pharmacists as members of the patient’s health care team. ACCP and CPNP also extended an offer to the committee to provide further information, data, and connections with clinical pharmacists in successful practices that provide CMM services. This information would help further inform the committee about this CMM service in the context of Medicare payment and delivery system improvements, which would in turn modernize and sustain the program for the future. Click here to read the ACCP/CPNP comments in full.
In addition, CPNP submitted separate comments calling for recognition and implementation of CMM within Medicare Part B, with a specific focus on beneficiaries with SPMIs (severe and persistent mental illnesses). Click here to read CPNP’s comment in full.
Additional Opportunities for CMM
The importance of CMM as part of the process of developing and implementing policies designed to streamline care coordination, improve quality, and lower Medicare costs is becoming more recognized within the health care policy community. ACCP has learned that several organizations also included calls for CMM coverage in their comments to the committee. These organizations include the Pharmaceutical Research and Manufacturers of America, the Biotechnology Industry Organization, GlaxoSmithKline, Blue Thorn Inc., and others. During the coming weeks, ACCP staff will continue reviewing the comments submitted to the Senate Finance Committee to identify other organizations advocating for Medicare coverage for CMM services.
Outlook for the Chronic Care Initiative
In conversations with staff from the offices of many of the key leaders in the Senate Finance Committee bipartisan working group on chronic care, ACCP has learned that Senate leadership—drawing from the input provided by stakeholders—aims to develop legislative language during the next few months and hopes to have a draft bill in place by the end of 2015. By congressional standards, this represents relatively rapid movement on this issue and provides a significant opportunity for ACCP to advance its Medicare Initiative. ACCP members should be prepared to engage with their elected officials during the coming months to help ensure the inclusion of a CMM component as part of the legislative package that emerges from this process.
Medicare Initiative Advocacy
ACCP members should take advantage of the August recess to engage with their members of Congress and help generate support for ACCP’s Medicare Initiative to establish a CMM benefit under Part B of the Medicare program. Here are four things you can do to help in this effort:
Invite your lawmakers to tour your practice setting.
Hosting a visit of your elected officials to your practice is perhaps the single most important thing you can do to help lawmakers understand what team-based, patient-centered clinical practice is all about—and to generate their support for recognition and payment for clinical pharmacists’ services.
A visit also serves as a means to establish an ongoing constructive dialogue with your senators or representatives and their staff on issues important to the delivery of team-based, patient-centered care.
A comprehensive guide to inviting a member of Congress to tour your practice site is available on our Legislative Action Center. If you would like to discuss the process of hosting a lawmaker at your practice site, please contact John McGlew at (202) 621-1820 or [email protected].
Schedule meetings with your members of Congress or their staff.
As the discussion on Medicare chronic care delivery demonstrates, health care remains a priority on Capitol Hill. The August recess presents an ideal opportunity to schedule meetings with your elected officials to discuss your practice, your patients, and the importance of establishing a Medicare CMM benefit. Click here to enter your zip code and obtain contact information for your elected officials.
Find and attend a town hall meeting.
To find out when and where these are held, check your members’ websites, their Facebook and Twitter accounts, and their local newspapers, or call their offices directly. Some town hall meetings are held online or by conference calls. These town hall meetings provide an excellent forum for addressing the issue of health care delivery reform and the future of the Medicare program. Clinical pharmacists should take advantage of this opportunity to discuss ACCP’s Medicare Initiative.
Send a letter to your lawmakers.
We have prepared a letter to Congress describing our Medicare Initiative that you can review and edit. You can send this letter in just a few easy clicks, but for maximum impact, we encourage you to personalize the letter by sharing some additional information about your clinical practice and the patients you care for.
Simply click here to visit our Legislative Action Center, and follow the instructions to send your message to your representative and senators.
Contact Us! For more information on any of ACCP’s advocacy efforts, please contact:
John K. McGlew
Director, Government Affairs
American College of Clinical Pharmacy
1455 Pennsylvania Avenue NW
Suite 400
Washington, DC 20004-1017
(202) 621-1820
[email protected]
1May 22 letter from Senators Orin Hatch, Ron Wyden, Johnny Isakson, and Mark R. Warner to health care stakeholders. Available here. Accessed August 5, 2015.