May 21, 2015

 

The Honorable John Thune
United States Senate
511 Dirksen Senate Office Building
Washington, DC 20510

The Honorable Debbie Stabenow
United States Senate
133 Hart Senate Office Building
Washington, DC 20510

Dear Senators Thune & Stabenow

The National Committee for Quality Assurance is pleased to endorse the Value Based Insurance Design Seniors Copayment Reduction Act of 2015 (S. 2783).

This important legislation authorizes a demonstration allowing Medicare Advantage plans to use value-based insurance designs to lower or eliminate cost sharing to promote evidence-based, high-value drugs, clinical services and providers.

A growing body of evidence documents that cost sharing inhibits use of high value primary care services and medications that help the chronically ill stay as healthy as possible.[1] [2] High co-pays also lower use of high value care, while reducing or eliminating co-pays increases their use and lowers use of high-cost care.[3] [4] Removing financial barriers to proven diabetes drugs, for example, helped Pitney Bowes reduce emergency room visits by 26 percent, with even greater savings over time from their VBID initiative.[5] [6]

Your legislation builds on this evidence by requiring careful evaluation of the demonstration’s impact on utilization, adherence, quality metrics, outcomes, beneficiary experience, and costs to plans for preferred providers. It also would let the Department of Health & Human Services make the program permanent unless the evaluation found increased costs or lowered quality.

Clinicians in NCQA recognized Patient-Centered Medical Homes (PCMH) and Patient-Centered Specialty Practices (PCSP) program are ideally qualified as high-value providers for these demonstrations. PCMHs transform primary care into what patients want it to be. That means they offer enhanced access after regular working hours and online so people can get care where and when they need it. They get to know patients in long-term partnerships, rather than hurried, sporadic visits. They explain treatment options and make decisions together with patients based on individual preferences, rather than simply give orders. Everyone in the practice works together as a team to get the most efficiency and coordinate care from other providers and community resources. They also pay especially close attention to prevention and managing chronic conditions to avoid complications, emergencies and hospital stays, which can reduce costs. A growing body of evidence documents that PCMHs lead to better quality, patient experience, continuity, preventive health and disease management, and lower costs.[7] [8] [9] [10] [11] [12]

PCSPs build on PCMH’s success to ensure effective communication and coordination between specialists and the primary care providers who make referrals to them. It includes written agreements on how practices will share information back and forth, as well as standards for enhanced access – including same-day appointments when needed, and population health management. We encourage you to specifically cite PCMH and PCSP providers as candidates for status as high-value providers in these important demonstrations.

Thank you for introducing this important legislation. If you have any questions, please contact Paul Cotton, Director of Federal Affairs, at 202 955 5162 or cotton@ncqa.org.

Sincerely,

Margaret O’Kane,

President

[1] Healthcare Spending and Preventive Care in High-Deductible and Consumer-Directed Health Plans, Buntin et al, American Journal of Managed Care, March 2011.

[2] Nearly Half of Families In High-Deductible Health Plans Whose Members Have Chronic Conditions Face Substantial Financial Burden, Galbraith et al, Health Affairs, May 2011.

[3] The Health Insurance Experiment, A Classic RAND Study Speaks to the Current Health Care Reform Debate, http://www.rand.org/content/dam/rand/pubs/research_briefs/2006/RAND_RB9174.pdf, 2006

[4] First-Dollar Coverage for Chronic Disease Care: Can It Save Money And Improve Patient Outcomes? UC Berkeley Center for Labor Research and Education, September 2008.

[5] Reducing Patient Drug Acquisition Costs Can Lower Diabetes Health Claims, Mahoney, American Journal of Managed Care, August 2005.

[6] Long-term investment yields significant results for employees, customers & shareholders, Mahoney, NBCH Value-Based Purchasing Guide, http://www.nbch.org/vbpguide.

[7] Perry R, McCall N, Goodwin S. Examining the Impact of Continuity of Care on Medicare Payments in the Medical Home Context, Presented at the AcademyHealth Annual Research Meeting, Orlando, FL, June 24, 2012, http://www.academyhealth.org/files/2012/sunday/perry.pdf

[8] Gabbay RA, Bailit MH, Mauger DT, Wagner EH and Siminerio L. Multipayer patient-centered medical home implementation guided by the chronic care model, Jt Comm J Qual Patient Saf 2011;37(6):265-73. http://ww.bailit-health.com/articles/062211_bhp_mpcmhi.pdf

[9] Maeng DD, Graf TR, Davis DE, Tomcavage J, Bloom FJ. Can a Patient-Centered Medical Home Lead to Better Patient Outcomes* The Quality Implications of Geisinger’s Proven Health Navigator, Am J Med Qual 2011; epub ahead of print Aug 18. http://ajm.sagepub.com/content/27/3/210.abstract?patientinform-links=yes&legid=spajm;27/3/210

[10] DeVries, A, Chia-Hsuan W, Sridhar G; Hummel, J; Breidbart, S, Barron, J. Impact of Medical Homes on Quality Healthcare Utilization and Costs, AMJC 2012; http://www.ajmc.com/publications/issue/2012/2012-9-vol18-n9/Impact-of-Medical-Homes-on-Quality-Healthcare-Utilization-and-Costs#sthash.vuXFYJRA.dpuf

[11] Takach, M, Reinventing Medicaid: State Innovations To Qualify And Pay For Patient-Centered Medical Homes Show Promising, Health Affairs, July 2011. http://content.healthaffairs.org/content/30/7/1325.abstract

[12] Harbrecht, M, Latts, L. Colorado’s Patient-Centered Medical Home Pilot Met Numerous Obstacles, Yet Saw Results Such as Reduced Hospital Admissions, Health Affairs, September, 2012. http://content.healthaffairs.org/content/31/9/2010.abstract