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ACCP Report

Washington Report

Senate Continues to Advance Medicare Chronic Care Reform Effort

Written by John McGlew
Director of Government Affairs


Capitol

The Senate Finance Committee, which has jurisdiction over the Medicare program, continues to advance legislation that will reform how care is delivered to chronically ill Medicare beneficiaries.

In May 2015, Senate Finance Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) announced the formation of a bipartisan working group to begin exploring solutions that will improve outcomes for patients requiring chronic care. Led by Sens. Johnny Isakson (R-GA) and Mark Warner (D-VA), the working group received comments from over 500 interested stakeholders, who provided ideas on ways the Medicare program can better deliver health care to beneficiaries with multiple chronic illness.

In April 2017, building on the efforts of the working group and stakeholder input, Hatch introduced S. 870, Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. This legislation includes provisions aimed at:

  • extending the “Independence at Home Demonstration” model of care;
  • expanding access to home dialysis therapy;
  • advancing team-based care by providing continued access to Medicare Advantage special needs plans for vulnerable populations;
  • expanding the use of health information technology by adapting benefits to meet the needs of chronically ill Medicare Advantage enrollees;
  • providing accountable care organizations (ACOs) the ability to expand the use of telehealth;
  • providing flexibility for beneficiaries to participate in ACOs and eliminating barriers to care coordination under ACOs.
    • What About Improving Medication Use?

      ACCP believes that the goals of the Senate Finance Committee working group are perfectly aligned with the College’s efforts 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 medication-related outcomes aligned with patients’ overall care plans and goals of therapy through the provision of comprehensive medication management (CMM).

      Over the past 2 years, ACCP staff in Washington have worked closely with leaders on the Senate Finance Committee working group to educate them on the importance of “getting the medications right” as part of this chronic care reform process and have urged the committee to include coverage for CMM in the legislation. Despite these efforts—and despite the acknowledgment by the Centers for Medicare & Medicaid Services that medications are the fundamental treatment intervention in each of the eight most prevalent chronic conditions affecting Medicare patients—S. 870 almost entirely ignored the medication use component. The legislation only included a proposal for a very limited Government Accountability Office study on improving medication synchronization.

      Next Steps

      More encouragingly, at a recent Senate Finance Committee hearing to mark up the legislation, Sen. Pat Roberts (R-KS) highlighted the importance of expanding access to medication management services within the Medicare program and acknowledged that medications are the most prevalent means by which chronic disease is prevented and controlled. During the hearing, Roberts, together with Sen. Tom Carper (D-DE), introduced an amendment requiring the Secretary of Health and Human Services (HHS) to establish a process, beginning in plan year 2020, by which a Medicare Part D plan sponsor can submit a request to HHS for claims data under Medicare Parts A and B.

      In its comments to the committee, ACCP thanked these senators for acknowledging the limitations of the current Part D medication therapy management (MTM) program and for recognizing that meaningful medication management services cannot be delivered solely on the basis of Part D claims data. ACCP’s comments also highlighted that Part D MTM programs are, by law, administrative in purpose and scope and that Part D plan administrators—not patients or clinicians—determine who can access an MTM program. ACCP’s comments urged Congress to cover CMM services provided by qualified clinical pharmacists as members of the patient’s health care team among its broader payment reform efforts.

      ACCP staff in Washington are due to meet with the offices of Roberts and Carper to continue urging them to consider opportunities to integrate and provide coverage for CMM across all settings of care that serve Medicare beneficiaries.

      We recognize the ongoing challenges we face in helping Congress fully understand how clinical pharmacists, practicing collaboratively with physicians and other members of the patient’s health care team, can bring enhanced quality and safety, improved clinical outcomes, and better managed health care costs to the Medicare program and its beneficiaries.

      However, we are encouraged that, despite the often politically fractured debate over health policy reform, the Senate Finance Committee remains focused on working in a bipartisan manner to improve care for chronically ill beneficiaries. We are confident that “getting the medications right” through providing CMM is central to achieving this goal.

      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 Ave. Northwest
      Suite 400
      Washington, DC 20004-1017
      (202) 621-1820
      [email protected]