Amer. Heart Assoc. Applauds Congress, CMS for Addressing Chronic Care Management in Medicare; Testimony Reminds CMS to Keep Focus on Improving Beneficiary Outcomes

5/11/2004

From: Kelly Kennai or Eric Bolton, 202-785-7900, both of the American Heart Association

WASHINGTON, May 11, -- The American Heart Association told the House Ways and Means Subcommittee on Health today that Medicare's new Chronic Care Improvement Program (CCIP) could help transition Medicare into a more responsive and comprehensive health care program for America's seniors.

Vince Bufalino, M.D., testified before the subcommittee on behalf of the American Heart Association. He applauded Chairman Nancy Johnson (R-Conn.), for her leadership in ensuring that chronic care issues were addressed in the Medicare Modernization Act. The Centers for Medicare and Medicaid Services released an RFP for the program in April. Bufalino said that CMS has done an admirable job in developing the RFP, but what will ultimately matter most, cannot be explicitly detailed in an RFP.

"True success will depend on the extent to which the program recognizes and promotes practices that provide value to the patient," he said. "By this, I am referring to improved outcomes, strategies to manage complex co-morbidities, the translation of evidence-based research into practice, the institution of measures to promote primary and secondary disease prevention, and effective beneficiary outreach so that beneficiaries can understand the program's benefits."

He added, "If, however, the program becomes overly focused on reducing expenditures, we are concerned that much of the potential value to the patient will not be realized."

The American Heart Association's Expert Panel on Disease Management established a set of principles on disease management and chronic care management based on extensive research. The association recommends the following guiding principles for the implementation of the CCIP to ensure improved patient outcomes for Medicare beneficiaries:

1. The main goal of chronic care improvement programs should be to improve the quality of care and patient outcomes.

2. Evidence-based guidelines should form the foundation for all chronic care improvement programs.

3. Performance measures should be designed to measure improved quality of care and clinical outcomes.

4. To ensure optimal patient outcomes, chronic care improvement programs must address the complexities of medical co- morbidities.

5. Frequent scientifically based evaluations should be a critical component of all chronic care improvement programs.

6. Chronic care management programs should exist within an integrated and comprehensive system of care, in which the patient-provider relationship is central.

Bufalino stressed that chronic care management programs should emphasize beneficiary outreach and education. Also CCIP programs should not replace the physician-patient relationship, but enhance it. He urged CMS to reject any proposals that attempt to supplant the care provided by a patient's provider of choice.

"Beneficiaries should know that this new program will not force them to give up their doctor or reduce their current benefits in any way," said Bufalino. "Instead, this pilot program should help coordinate what often times is the fragmented health care system through which beneficiaries receive care."

A complete description of the American Heart Association's chronic care management principles and copies of the full testimony are available upon request.