July 20, 2010
The Honorable Tom Harkin
Chairman
Appropriations Subcommittee on Labor, Health and Human Services,
Education and Related Agencies
U.S. Senate
Washington, DC 20510
Dear Chairman Harkin:
The Campaign for Better Care is a multi-year initiative focused on improving
delivery and payment for health care services in ways that enhance quality and
coordination of care for older patients and individuals with multiple health
problems. We greatly appreciated your leadership during the health reform
debate. During this crucial implementation stage the Campaign stands ready to
work with you to ensure that health care reform delivers on the promise of putting
patients first and improving the quality and coordination of care they receive.
The recently enacted Affordable Care Act (ACA) includes a number of provisions
designed to give older adults and individuals with multiple chronic conditions the
comprehensive, coordinated health care they need. In order to realize the
promise of these provisions we respectfully request that your Subcommittee fund
the following four programs designed to improve health quality through delivery
system reform:
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Shared decision-making
Quality measure development
Primary care extension programs
RELG data collection efforts
Shared Decision-Making
Section 3506 of the ACA establishes a program to facilitate adequate information
and collaborative processes between patients, family caregivers, and clinicians
so that all parties share in the decision-making process and enable patients to
make decisions that best meet their individual need and preferences.
Shared decision-making must become an integral component of the patientclinician relationship. A patient’s treatment choices should be based on clear
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The Campaign for Better Care is led by the National Partnership for Women & Families, Community
Catalyst, and the National Health Law Program and funded by The Atlantic Philanthropies.
understanding of their options and their trade-offs and should be consistent with
the patient’s values, preferences, and life situation. Truly informed patients can
play a more active role in decisions about their care, working with their health
care providers to pursue treatment that matches their needs and preferences.
Numerous studies have documented that a patient’s use of shared decision aids
results in reduced rates of elective surgery in favor of more conservative options.
The Foundation for Informed Medical Decision Making found that for 70 percent
of people who have a heart bypass operation, the result would have been the
same if they had chosen medication alone. Many of those patients were probably
unaware that they had more than one treatment option, and would likely have
chosen a different – and potentially less invasive and less costly – option.
The new law authorizes such sums as are necessary to implement this program
for FY 2011 (and each subsequent fiscal year); we request an appropriation in
the range of $30-$40 million in order to fund adequate grants and contracts to
develop, test, and disseminate educational tools necessary for providers to assist
patients and caregivers with decision-making.
Quality Measure Development
An essential early step towards achieving improved health care outcomes and
value is the ability to measure quality of care. The systematic, transparent
development of measures that support quality improvement and payment reform
are essential to improving clinical outcomes for patients, often at a lower cost.
These measures are also necessary to accurately assess the new models of
care created by the ACA – like patient-centered medical homes and accountable
care organizations. Further, measure development in “gap areas” – where solid
measures do not yet exist – will help improve care for the highest risk, highest
cost patients.
Section 3013 of the ACA provides an authorization of $75 million for FY 2011 to
facilitate development of patient-centered quality measures where the Secretary
of Health and Human Services has determined gaps or needed improvements
exist.
We strongly urge the full authorized level so that progress can be made as
quickly as possible on the development of measures that will drive continuous
improvements system-wide.
Primary Care Extension Programs
Patient centered models of care rely on well trained primary care providers.
Section 5405 of the ACA establishes a Primary Care Extension Program to
educate and provide technical assistance to primary care providers about
evidence-based therapies, preventive medicine, health promotion, chronic
disease management and mental health.
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The ACA authorizes $120 million for FY 2011 and would allow the new program
to assist primary care providers in incorporating evidence-based therapies and
approaches into their practice and thus improve community health. We urge you
to fund these Primary Care Extension Programs at the fully authorized level.
Health Care Disparities and Data Collection
Collecting accurate data on race, ethnicity, and language is an essential step
towards identifying and eliminating racial and ethnic health disparities. The issue
of health disparities is widely documented, including in reports from the Institutes
of Medicine: Unequal Treatment and Race, Ethhnicity and Language Data:
Standardization for Health Care Quality Improvement. And yearly reports from
HHS’ Agency for Healthcare Research and Quality identify ongoing disparities,
including some that are actually increasing.
Unfortunately, much of the demographic data currently collected by HHS is
neither standardized nor comprehensive. For example, an analysis of 2002
Medicare administrative data show that only 52% of Asian beneficiaries and 33%
of both Hispanics and American Indian/Alaska Native beneficiaries were
identified correctly. Section 4302 of the ACA provides significant steps forward
to ensuring the comprehensive and accurate collection of race, ethnicity,
language, gender and disability data.
We urge you to fund data collection efforts in the range of $40-$50 million to
ensure that efforts can get underway to collect the information necessary to
identify disparities and determine appropriate interventions to remedy them.
Conclusion
The Campaign for Better Care and our member organizations thank you for
considering our request and we look forward to working with you to secure
funding for these four critical programs.
Sincerely,
Advocacy for Patients with Chronic Illness, Inc.
AFL-CIO
American Hospice Foundation
Coalition of Wisconsin Aging Groups (CWAG)
Caring From a Distance
Community Catalyst
Consumer Health Coalition
Consumers Union
Empowered Patient Coalition
Families USA
HEREIU Welfare Fund
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The Leadership Conference on Civil and Human Rights
Medicare Rights Center
Mothers Against Medical Error
National Coalition for Cancer Survivorship
National Family Caregivers Association
National Health Law Program (NHeLP)
National Partnership for Women & Families
North Carolina Justice Center’s Health Access Coalition
U.S. PIRG
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