Seniors Health Care Town Hall

Uploaded by whitehouse on 11.06.2012

Kathy Greenlee: Good morning, everyone.
Thank you for joining us this beautiful morning this summer.
I'm Kathy Greenlee.
I am the Assistant Secretary for Aging as
well as the Administrator of the Administration for
Community Living.
I am so glad that you could join us.
As I look at the audience, I see many,
many faces that I am familiar with,
many of you who I know advocate every single day on behalf of
our nation's seniors.
So I want to thank you for what you do every day.
But thank you for joining us here this morning as we focus
specifically on senior's health and opportunities under the
Affordable Care Act.
So thank you all for joining us.
I would like to acknowledge the White House and the White House
staff who helped us put this together at Health and
Human Services.
We have a wonderful partnership and are glad to be able to bring
this event together with you.
We have a number of people in the audience this morning,
but we are also videocasting this online.
So you will likely hear from us questions that come from the
audience who are watching online and tweeting their questions.
So we will hopefully get some tweets that come in.
Those of you who can access your Twitter accounts are
certainly welcome to send questions that way.
But we will also take questions from the audience.
The hashtag that we use, for those of you that want to send a
tweet is SeniorsHealth.
SeniorsHealth is the one to use.
And I have had the opportunity to do a Twitter event before on
seniors' issues.
We often get way more questions than we can answer.
We'll do our best to be responsive.
But also, we'll try to follow up for those of you,
if we don't get to your specific questions.
We have a wonderful presentation or group of panelists with you
this morning.
And I want to just kind of go down the row and tell you who is
here with us.
On the end is Jonathan Blum.
Jonathan is the Deputy Administrator and Director of
the Center of Medicare at the Centers for Medicare and
Medicaid Services.
Next to him is Jim Firman.
Jim is the President and CEO of the National Council on Aging.
Jim also currently serves as chair of the Leadership Council
of Aging Organizations.
Next to him is Sandy Markwood.
Sandy is the CEO of the National Association of Area
Agencies on Aging.
And on the end, Dr. Louise Chang.
She is the Senior Medical Editor for WebMD.
So we have a very fine panel for you today.
We're hoping that this event this morning can help us further
the conversation about seniors and their health needs.
And I wanted to start by just sharing with you an experience
that I had a couple of months ago.
As you may know, March 23rd was the two-year anniversary of the
Affordable Care Act.
And that week, on the 19th specifically,
I had the chance to do a similar event in Albuquerque,
New Mexico with seniors directly at a senior center.
And I felt like the seniors that morning provided us a real good
example of the range of questions that seniors have but
also the different type of seniors that we serve.
So I wanted to briefly tell you who was there that morning.
In Albuquerque on that Monday, there were a number of seniors
who had recently retired.
And they were quite active.
They had a lot of questions.
And what they wanted to know is: How can we help get the word out
about the Affordable Care Act, How can we make sure that
seniors know what's available?
And they are ready and willing to mobilize with us to talk
about the Affordable Care Act.
And so we need to work with those individuals who can be
good partners for seniors.
There are other seniors that morning who had slightly
different questions.
Their questions were much more about themselves and their own
concerns: What is the coverage gap that we know
as the donut hole?
How does the Affordable Care Act help me?
What can I do -- and what are these new preventive services?
And their questions, this other group of seniors,
were also more broad.
How does this help my family?
How does the Affordable Care Act help my grandchildren?
And then there was the third group of seniors.
And they're less active, more quiet because they
were more frail.
I had a staff person with me that morning who whispered to me
later, she said, you know, I think that one woman just got
out of the hospital.
And for that group of seniors, we need to talk about the
Affordable Care Act in the way that it strengthens Medicare.
Medicare is critically important for seniors.
We need to talk about our efforts to crack down on fraud,
to extend the life of the Medicare Trust Fund,
to keep Medicare safe so it's there for the seniors now who
need it but all of us who hope to become seniors and join this
fine group of people we represent.
We hope today that we can generate questions and answers
along that full range, from the strength of Medicare to the new
opportunities, but also how Medicare and the Affordable Care
Act changes in specific are helping all of our nation's
seniors, as well as their families.
So my honor, to next turn this over to a wonderful guest that
we have with us this morning from the White House,
Cecilia Muñoz.
And I would like to be able to introduce Cecilia to you.
Cecilia Muñoz is the Director of the Domestic Policy Council
which coordinates the domestic policy making process in the
White House.
Prior to this role, she served as Deputy Assistant to the
President and Director of Intergovernmental Affairs where
she oversaw the Obama administration's relationship
with state and local governments.
Before joining the Obama administration,
Cecilia served as Senior Vice-President for the Office of
Research, Advocacy, and Legislation at the National
Council of La Raza, NCLR, which is the nation's largest Latino
civil rights organization.
She supervised NCLR's policy staff,
covering a wide variety of issues of importance to Latinos,
including civil rights, employment, poverty,
farm worker issue, education, health, housing,
and immigration.
Her particular area of expertise is immigration policy where she
covered at NCLR for 20 years.
Please help me in welcoming Ms. Muñoz this morning.
Thank you.
Cecilia Muñoz: Thank you so much, Kathy.
Good morning, everybody.
Audience: Good morning!
Cecilia Muñoz: Welcome to the White House.
We're so excited to have you here.
And we're looking forward to a really interesting exchange.
And what I appreciate the most about the exchanges that we've
been having on the Affordable Care Act is how much we learn
from them and how much we are guided by seeing the world as
you see it, seeing the implications of this law as you
see it, knowing what you know and making sure that we're
gathering the information that you presented to the process.
Because it was instrumental in helping us develop the law.
It's instrumental in helping us implement the law.
This is incredibly important feedback for us.
So thank you so much for taking the time to help guide our work.
This administration's working very hard to protect the health
of seniors.
And we know that today 49 million people rely on Medicare
for their medical treatments, the prescription drugs that they
need to get healthy and to stay healthy.
And one of the top priorities of this administration is to
protect the Medicare program and ensure that it will be there for
the current generation, but for future generations of seniors.
And so as part of these efforts, the President has made it a
priority to make sure that we're fighting Medicare fraud as a
major priority.
And that's what I'm going to focus on a little bit in my
remarks this is morning.
This is something that takes, essentially,
resources out of the pockets of seniors,
out of the pockets of tax payers and fundamentally weakens
the program.
This is why it's a priority.
And fortunately, our efforts to fight fraud in the program are
making a real difference.
We have more than quadrupled the number of antifraud strike force
teams that are operating around the country.
And the number of individuals that have been charged with
criminal healthcare fraud has increased from about 800 in the
year before the President took office to more than 1400
last year.
And the Affordable Care Act has given us powerful new tools to
support these efforts.
Using technology that's similar to what credit card companies
use, we can identify and stop suspicious payments before they
go out when there are credible allegations of fraud.
And we can keep bad actors out of the Medicare program in the
first place through a tougher screening process that targets
the areas, the sectors where we see the most fraud.
We see the fight against fraud as fundamental to our efforts to
strengthen and protect the Medicare program and make sure
that it's as strong as possible for the future.
And according to Medicare experts,
the Affordable Care Act, including some of its key
antifraud provisions, has extended the life of the
Medicare Trust Fund by eight years, to 2024.
So that's progress that's moving us in the right direction.
So we are committed to continuing to strengthen the
program and getting the criminals out of our healthcare
system so that we can ensure that seniors and other
vulnerable citizens across the nation will have access to
high-quality affordable healthcare that they need,
they that they deserve, that they've earned.
So with that, I'm really looking forward to our conversation.
And it falls to me the honor of introducing our wonderful
Secretary of Health and Human Services.
She was the Insurance Commissioner of the state of
Kansas before she became the governor of the state of Kansas.
And she knows the healthcare system from every angle.
And she has been a forceful advocate for the health needs of
Americans, for the Affordable Care Act.
We are incredibly lucky to have her as our Secretary of Health
and Human Services.
Ladies and gentlemen, Kathleen Sebelius.
Kathleen Sebelius: Well, good morning, everybody.
And thank you, Cecilia, not only for those nice comments but for
the great work you do as head of the Domestic Policy Council.
I want to recognize and thank our panel members for being a
part of this discussion today.
And two of our great health leaders at HHS are here,
Jon Blum who many of you know runs the Medicare program and
is, I can tell you, a tenacious and tireless advocate on behalf
of the 48 million beneficiaries who rely on those services.
And Kathy Greenlee who serves now in kind of a dual capacity
as the Assistant Secretary on Aging but also is taking on a
new role as the head of the new Administration
on Community Living.
I've known Kathy for a long time.
We worked together in Kansas.
She is incredibly well suited for this job.
And it's great to have a chance to be with all of you today.
You know, Medicare has now been in place for about 50 years,
since 1965.
And it really changed the lives of seniors in this country.
I don't think that can be overstated.
It served as a promise that seniors and persons with
disabilities wouldn't lose their life savings,
wouldn't lose their houses, wouldn't lose their kids'
inheritance if they got sick.
And they would be able to access benefits that they needed when
they needed them.
Over the past few decades, I think,
Medicaid has made very good on that promise.
We have about 48 million Americans relying
on that program.
And 11,000 baby boomers a day become eligible for Medicare.
We have the biggest group ever in the history of this country
coming in on a daily basis as the baby boomers age.
And as you've just heard Cecilia mention,
thanks to the Affordable Care Act,
Medicare is stronger than ever.
Before the law was passed two years ago, and signed into law,
there were gaps in Medicare coverage that
we're working to fill.
Now, while the addition of the Part D Medicare benefit was
hugely available for lots of seniors, it was, I would say,
written with a design flaw so that the seniors who took and
relied most heavily on medications ran out of their
insurance coverage at some point during the year and ran into the
so-called donut hole.
So one of the issues that the Affordable Care Act addresses is
the closing of that gap in coverage,
the donut hole coverage.
And we know that up until this past year,
about one in four seniors reported skipping doses,
cutting pills in half, not filling prescriptions at all,
which is, in the long run, far more costly to not only a
patient's health but to the healthcare system itself because
they're more likely to be hospitalized.
They're more likely to be vulnerable to acute situations.
But that's the only choice they had when you ran out of money.
Seniors also found critical and potentially life-saving
preventative services like mammograms,
colon cancer screenings often out of reach due to copays
and deductibles.
But those gaps are currently being closed.
Now, seniors who hit the donut hole this year in 2012,
are receiving a 50% discount on their brand name drugs.
And that will, over time, close entirely.
But what we know is a little bit of a snapshot, that since 2010,
when the healthcare law was signed,
over 5 million beneficiaries have saved an average of
$635 each.
That's real money in people's pockets and has enabled their
resources to go a lot further.
More importantly, they are filling prescriptions they may
have otherwise skipped.
And the savings to those seniors will continue to grow
every year.
And at the same time, as you all know,
the law has now made recommended preventive services available
with no copay and no deductible.
And while that sounds like a modest change,
I can't tell you how many people we talk to who say,
I won't worry anymore about if there's money in the checkbook
to cover this.
Also, what we know is that that information is getting
around to seniors.
We have about 14 and a half million beneficiaries who have
already taken advantage of some of those free preventive tests
and screenings.
One additional feature is an annual wellness visit.
Now, while you had a welcome to Medicare annual visit included
as part of the program, an annual wellness visit was not
included for seniors.
And if you think about keeping people healthy in the first
place, developing a healthcare plan with a primary care
provider and then following up on that plan is a great way to,
again, keep folks healthy.
The law doesn't stop there.
We have begun to change payment systems so it's easier for
doctors to work together, to deliver the kind of high quality
coordinated patient care that we know is available in the
country's leading health systems.
And even with those benefits being added,
the Medicare premiums have fallen or remain lower than
projected over the last two years.
For example, we know that premiums in Medicare Advantage
Plans have fallen an average of 7% between 2011 and 2012,
while enrollment continues to go up.
And that's in part because of the historic waste in fraud
efforts you heard about from Cecilia.
And it's in part because Jon Blum and his team have done some
great job using the negotiating power for Medicare Advantage
that they were given as part of the Affordable Care Act and the
directives that they were given.
So we have found that market not only to be robust but also yield
to competition.
So when you add savings in the law,
we are projecting that the Medicare beneficiaries will save
about $4200 over the next nine years.
And those seniors with high drug costs could save up to $16,000.
Again, a big step forward.
So unlike some recent proposals floating around Congress that
would actually destroy the Medicare program as we know it
and shift to a defined contribution,
away from defined benefits, the Affordable Care Act really
maintains the guaranteed benefits that seniors count
on today.
I just came from a weekend visit with my 91 year old father and
my 92 year old aunt.
And so when I think about Medicare,
I start with them and know how much they rely on this program.
My dad was actually in the United States Congress sitting
on the Energy and Commerce Committee when Medicare
was written.
And I can tell you he is happy that that law passed at the time
that it did and now is a thankful beneficiary.
But there are lots of seniors and those with disabilities
around the country who are just as dependent on those
critical benefits.
What we're determined to do is make sure that Medicare is
stronger than ever, that seniors will have benefits,
lower prescription costs, and more affordable preventive care
and that their children and grandchildren will have a
stronger Medicare in the future.
Again, I appreciate you being part of this important
conversation today.
We look forward to your input and your ideas and strategies
about how we move forward together.
And now I would like to turn over the program back
to Kathy Greenlee.
Kathy Greenlee: Thank you very much.
It's always good to have the Secretary with us.
We really do want this to be audience participation.
For those of you watching at home,
be sure and send in your questions.
#SeniorsHealth if you have questions.
We also have two people who have microphones who can help with
your questions, so they will spread out and we'll be able to
do questions and answers.
Let me start, kick things off and get you all warmed up this
morning by starting with Dr. Chang.
As I mentioned, Dr. Chang is the Senior Medical Editor
with WebMD.
Dr. Chang, what are the most common questions or could you
start us off with a good question that comes up quite
often for you with your audience?
Dr. Chang: Sure.
First I would just like to thank you for inviting WebMD to this
special event.
As both a physician and patient advocate,
I look forward to being part today's conversation.
As you know, WebMD has a very engaged online and
mobile audience.
And we've had many of our users tell us about problems they've
had finding a primary care physician,
given the growing shortage of primary care doctors and the
increasing number of those doctors who are no longer
accepting patients on Medicare/Medicaid.
We have one story from a pharmacist who told us about a
woman with multiple medical problems literally going through
a phone book trying to find a doctor who would accept her
as a patient.
And she was not able to find one.
And another comment comes from a WebMD user named Katherine who
says that her inability to find a good primary care doctor is
putting her health at risk.
So on behalf of the WebMD users, my first question is,
How will concerns about access to doctors be addressed by the
Affordable Care Act?
I think, as the Secretary talked about,
the Affordable Care Act gives the agency tremendous new tools
to think about payment changes and other reforms to help
physicians work more closely with their patients.
We have the new Accountable Care Organizations program that
started this year really trying to promote better care
coordination, better care delivery throughout the country,
very much modeled on the best delivery systems across
the country.
So we're trying to change how we think about services and to
promote more primary care, more primary care interaction.
In addition to the accountable care model,
we're also promoting much stronger systems for primary
care for all the senior population within the
Medicare programs.
A real strong goal is to make sure that care is better
coordinated, more integrated, and to increase the patient
experience for physicians and their patients.
Kathy Greenlee: Let me give a second one to Dr. Chang.
And then, audience, are you ready?
Because I'm coming to you to see if you have questions.
Dr. Chang: The WebMD network includes Medscape,
the leading online provider of information for physicians and
other health professionals.
And this question was raised by one of our primary care advisers
at Medscape on behalf of many patients who were concerned
about rising healthcare costs.
The question goes, Baby boomers can expect to live longer,
but at a cost.
They can also expect to develop conditions including
Alzheimer's, diabetes, heart failure, cancer,
and other heart disease, kidney disease.
And many of these conditions can now be treated with life longing
but often very expensive procedures, devices, and drugs.
Given this huge patient population,
how can any healthcare system, public or private,
support the trillions of dollars these treatments will cost?
Jonathan Blum: I think from our perspective at CMS,
it's a multi-factor approach.
One approach is to make sure that care is safer and more
coordinated and to take out the waste when care is
not coordinated.
The second,as the Secretary talked about,
is to ensure that we're doing everything that we can to take
out fraud, waste, and abuse.
And the third is just to make sure that we're vigilantly
managing the benefits that we pay for.
We have put in place new competitive payment models for
certain services.
We have put in place new payment ways to ensure that we're paying
as accurately as possible to make sure that the Medicare
program is as modern as possible.
And we're already seeing very good results so far.
Over the last couple of years, we've seen very modest growth to
the overall Medicare program which tells us that,
if we really focus on fraud, refocus on better care
coordination, make sure that care is safer to ensure that we
are overseeing the payment systems very forthright,
that this very modest growth can continue for some time to come.
Kathy Greenlee: Thank you, Jon.
We have questions from the audience?
I'm just going to kind of go back and forth across the room.
So Carol, if you will help us.
It is helpful for people if we use the mic.
Thank you.
Brenda Sulick: Thank you.
I'm Brenda Sulick with the National Committee to Preserve
Social Security and Medicare.
And as some of you know, we have an initiative at our
organization called Patients Aware where we are working with
healthcare providers throughout the country and going into
places where seniors are and educating them about the
Affordable Care Act.
So I have two questions.
One is -- data is really important.
As we tell folks, you know, you can save -- people are
saving over $635 with Part D and why this is important.
I haven't found any information specifically on preventive care
and services.
I know millions of people have taken advantage of this.
But I wondered, first, if there's any data that would give
us an idea of how much a person saves on average since it's been
put into place, the law?
Kathy Grenlee: Let me -- can I add a question to your
question while we go?
Brenda Sulick: Yes.
Kathy Grenlee: Because I think we're going to give Jon a break.
Not just the data but the take-up rate,
because I think one of the issues that comes up in the
senior advocacy community is how best to talk about this benefit.
And I know one of the things that we've been concerned about
is that we have all populations take advantage of the Medicare
preventive benefits, that this can be a real issue where we
need to talk to all communities.
Health disparities are real, and we want to make sure that
everyone gets to take advantage.
So Jon, what's out there that CMS might have,
both in terms of the question on savings but also the uptake at
this point on preventive benefit?
Jonathan Blum: Well, I think that the savings varies
by the beneficiary.
Each beneficiary has their own unique spending needs.
Depending on his or her needs, there's going to be more
savings, particularly with pharmacy costs.
So those that have the highest pharmacy costs will benefit most
from the coverage gap changes that went into place a couple
years ago.
But the savings come from several sources.
One is lower premiums.
Both the Part B and Part D premiums right now are lower
than projected.
We have the new wellness visit that's free to Medicare
beneficiaries that we're encouraging all beneficiaries to
take advantage of.
Preventive benefits that are recommended now are free cost
sharing for those beneficiaries that choose to take advantage of
those services.
For those beneficiaries who are on the private side of Medicare,
the private plan side, premiums have fallen over the last two
years tremendously.
So the savings will vary by beneficiary,
depending on how they receive services, their own care needs.
But our goal is to make sure that the trust funds
are preserved.
But that also produces savings to the beneficiaries because
beneficiaries pay through premiums, through cost sharing.
So as the trust funds do better, so do beneficiaries.
Cecilia Muñoz: If I could just add, I mean,
we're just coming out really our first full year of
implementation, which is part of the reason that we don't have
precise specifics as to how much individuals are savings as a
result of access to preventive care.
We do know that significant numbers of seniors have accessed
their first wellness visit without having copays
or coinsurance.
But I would like to thank you for the work that you're doing
in conducting outreach and helping educate folks because
the many benefits of this law, the access to preventive care
without copays and coinsurance and the other protections for
patients are, frankly, only as good as people's
awareness of them.
So in order for the law to be successful, I mean,
it sort of hinges on the notion that if you can provide
preventive care to people successfully than you avert
other costs in the future.
We're trying to get away from the model in which people
receive medical care really when a situation has become an
emergency, which is both obviously not good for their
health but obviously also has huge cost implications.
So part of our effort and part of the reason that this
partnership is so important is that our job also includes
making sure that people understand what's available to
them under this new law so that they can access it,
both for the sake of their health but also because that's
how we're driving people's costs down.
Kathy Greenlee: I might take this opportunity to also ask Jim
and Sandy questions along this line with regard to preventive
benefits because I know both of you and your members and
affiliates have been working on this issue.
What are you doing in terms of outreach on the preventive
benefit and what are you hearing in terms of other issues that we
need to be aware of?
Jim Firman: Thank you, Kathy.
It's a pleasure to be here.
To reinforce the point that's been made,
our research shows that most seniors still don't know what's
in the law.
They do not realize all of the good things it does,
not only in terms of strengthening benefits.
Most of them don't realize that the law extended the
solvency of the Medicare program for eight years,
which is a fundamental concern for everybody.
So we have to remember that we have to keep educating people.
Not enough people are using the preventive benefits.
And part of it is becoming more aware of it.
The wellness benefit is something that seniors
don't realize.
You don't talk to your doctor.
You don't have to get undressed.
It's just a conversation about what you can do to stay healthy.
But not enough seniors are taking advantage of it.
So we are working with thousands of community organizations
across the country, private and public,
to educate seniors about the law,
also to educate them about extra help that's available to cover
almost all the prescription drug costs or some of the Medicare
savings program.
So our main message is, as Cecilia said,
this is a really good benefit but you have to use it to
maximize the opportunity.
Kathy Greenlee: Thank you, Jim.
Sandy Markwood: Thank you, Kathy.
And I would like to echo Jim's comments.
Through the Area Agency on Aging network, the state units,
and all of the service providers in the Aging Network,
getting the word out about all of the values of the Affordable
Care Act has been one of our major priorities.
But as Jim said, we've got a long way to go.
In looking at that, I think that we have opportunities through
the open enrollment through Medicare Part D to expand that
into telling the older adult population and their caregivers
about the value of the preventive benefits.
I think that we need to use, as an aging advocacy community,
every opportunity we can to ensure that older adults,
Medicare beneficiaries, understand how valuable these
preventive benefits are and how critical they are to looking at
ensuring their health.
When you're looking at the three-part aim; better help,
better care, and lower cost, it really is embodied in all of
the benefits in the Affordable Care Act.
Kathy Greenlee: Thank you.
Do we have a question from this side of the room?
Christine Sequenzia Titus: Good morning.
Christine Sequenzia Titus with the American Society of
Consultant Pharmacists.
We know that consultant pharmacists save a significant
amount of money through drug regimen reviews and long-term
care facilities.
And we wonder how you see their role developing in the
interdisciplinary team as the ACA progresses.
Jonathan Blum: The one clear goal for the Affordable Care Act
is to make sure that we build stronger care coordination
activities, that we link the benefits much more closely
together with hospital benefits, physician benefits,
pharmacy benefits, long-term care benefits.
We know that when providers practice in teams that care is
safer, that care is better coordinated.
So a lot of the changes that are in the Affordable Care Act
really around to ensure that healthcare is more integrated,
that benefits are brought together.
For example, with the wellness visit,
one of the elements to have the physician review the pharmacy
medications each year to ensure there's no harmful interactions.
And that's consistent to how we want care practiced throughout
the healthcare delivery system, be it in the physician office
setting, the long-term care facility,
really to make sure that we avoid bad interactions with
medications, that pharmacy benefits are used to keep
people healthy for longer periods of time.
But that's really the goal that's throughout the Affordable
Care Act, to ensure that data, that integration,
that care coordination is throughout the entire healthcare
delivery system.
Kathy Greenlee: Let's check in with Julia.
Do you have any online that you want to chime in with?
Julia: We have one question from Twitter.
And it says, What are you doing to protect home health benefits?
Cecilia Muñoz: Say that again.
Julia: What are you doing to protect home health benefits?
This question came in from Twitter.
Jonathan Blum: We believe that we can provide care at
different healthcare settings and that not all care has to be
provided within the hospital setting or the nursing
home setting.
So throughout both the Medicare programs, Medicaid programs,
a huge emphasis is to help beneficiaries return home to
the community faster.
That can happen in part by home health being much more
strongly integrated with the overall benefit.
We want to make sure that beneficiaries don't have to
return to the hospital when they don't need to.
That's not good for the beneficiary.
That's not good for healthcare costs.
And really, we're trying to put in place knew strategies to help
beneficiaries stay home, stay in the community so they can be
happier and be closer to their families.
We're doing that through various mechanisms of building more
accountable healthcare systems that really take a more complete
picture of patient care.
The one strategy that we have to reduce overall costs is to make
sure that beneficiaries don't come back into the hospital or
that that can be managed much more effectively where they want
to be, or they want to receive care through their own homes.
Jim Firman: Another thing that many people don't realize
is that the law strengthened the Medicaid provisions to provide
incentives for more states to provide in-home services
as opposed to institutional services.
This is a significant step forward because that's what
people want, care, wherever possible, in their own homes.
Kathy Greenlee: Dr. Chang?
You told me you have plenty of questions,
so I want to chime back in with you.
Dr. Chang: I do.
This question comes from a WebMD community member named Dave
who's a caregiver of a father with Alzheimer's Disease
diagnosed last year.
And he says I am the responsible party and have finally found him
an excellent assisted living facility.
But assisted living facilities are private pay only and no
health insurance covers the cost, which could be quite high.
Two part question.
Will assisted living facilities ever be covered under any health
insurance plan?
And will the fees for an assisted living facility ever be
considered a tax credit rather than a deduction?
Kathy Greenlee: I might start on this.
And then we can just kind of chime in if other
people have questions.
The underlying question is what is the best way to pay for
assisted living?
Long-term care, as people in the room know,
as the people watching know, is a huge expense for older adults.
The primary source for payment for long-term care expenses is
someone's own resources at this point.
In this country, the second most common way to pay for long-term
care is through Medicaid.
The Medicaid program is designed to cover nursing home care,
not assisted living but a skilled nursing home which is,
by definition, a higher level of acuity, higher level of care.
The states will provide home and community based services
for Medicaid.
And it's just situational, depending on the particular
state and how the program is designed.
I think it's most common that individuals can receive home and
community based services on Medicaid in an assisted
living facility.
But that's the services.
And the main cost and part of the largest expense in assisted
living is the basic rent and kind of the room and
board aspect.
And that's really not sort of the reach of the
Medicaid program.
So we continue to work kind of, I think,
more broadly with the senior community to plan for long-term
care, to look at what the options are for other kinds of
services that can be purchased in the community,
but also support people as they progress and have higher needs.
There are expansions in the Medicaid program that Jim
mentioned, greater incentives for states to rebalance their
long-term care system, to continue to provide
additional waiver services.
But someone who is not Medicaid eligible,
who has Alzheimer's -- and often Alzheimer's can be supported in
an assisted living facility first before skilled care.
That will primarily be someone's own resource,
unless they have long-term care insurance that could cover it.
All right.
Let's check in with the audience.
We're going to come back over here.
Sarah Lock: Good morning.
I'm Sarah Lock from AARP.
I understand that there are provisions in the Affordable
Care Act that help fight against elder abuse.
Could any of the panelists talk about some of those?
Kathy Greenlee: This is one of my favorite topics.
So we'll now spend the rest of the hour -- You know,
the advocates for the issue of elder abuse worked for about ten
years trying to get the Elder Justice Act passed in front
of Congress.
The Elder Justice Act did pass as a part of the Affordable Care
Act, and this was celebrated as a great victory,
as it should be.
The advocates have really raised the issue of elder abuse which
many of us feel is decades behind the issues of domestic
violence, sexual adult, child abuse.
So this was a good victory, but an incomplete one because
when the Affordable Care Act was passed,
there was authorizing language but not appropriations for the
Elder Justice Act.
For the past two years in a row, the President has recommended
that the Administration on Aging,
now the Administration for Community Living as well,
receive appropriations to begin to implement the Elder
Justice Act.
So we will continue to raise this issue,
to move forward on this issue, both with regard to the
opportunities that were brought to us by the Elder Justice Act.
But the Assistant Secretary has a broader responsibility beyond
the Elder Justice Act.
The Older Americans Act has always been broad enough,
in responsibility and charge, to make sure that we as a network,
really as a nation, work on this issue.
And so we are looking for additional partners,
additional opportunities, and ertainly rely on the broader
aging network.
We have an increasing numbers of seniors coming.
We all know about the age wave.
And with more seniors is more abuse, just based on data.
So thank you for raising it.
I don't know if any of our other partners want to address it.
Jim Firman: Yes.
NCOA was proud to be part of the coalition that finally got the
Elder Justice Act into law.
And now we do believe that's important,
to appropriate funding.
We've heard from the Secretary of HHS how well the investment
in fighting fraud and abuse in the Medicare program is
paying off.
And now we need to invest in preventing fraud and abuse among
older individuals, because they are the victim.
And it's a tremendous cost to society.
So we're half-way there.
But this is a great piece of legislation.
But more people need to speak out in support of it.
Susan Markwood: Well, I would like to echo the fact that we
need to get it funded because when you look at the statistics
from the xxNaswwod survey, with the economic downturn,
there's been a rise in calls and instances of APS.
And also, what we find through the elder care locater,
when we have more and more older adults and caregivers calling
in, well, we've got more calls about fiduciary abuse where
actually banks are referring older adults to call us because
the incidences of fiduciary abuse are on the rise too.
So if we ever needed to be able to get this act funded,
it's now.
Kathy Greenlee: So when I opened earlier,
I talked about that one of the beauties of this particular
event is the joint partnership between the White House and
Health and Human Services.
On the topic of elder abuse, we also have leadership from both.
As I mentioned, the President has put this in the budget for
us the last two years.
We do have the White House's commitment and interest on the
topic of elder abuse, as well as the Secretary's.
So we have support.
We all, I think, need to continue to raise this as an
issue, do what we can wherever we work, on whatever issues.
But we do have leadership and support here.
Cecilia, I don't know if you have anymore.
Cecilia Muñoz: Yea, Let me just echo that.
This is absolutely a partnership.
And this is an important priority.
It's something that the White House will continue to advance
along with the department.
But it does call into question the fact that the conversation
that's happening about the federal budget is very,
very relevant because we're in a very sort of fundamental debate
where, frankly, there is a budget that's been proposed on
the other side of the aisle which really decimates a lot of
the priorities that this President is trying to advance.
In order to be successful, we have to be successful also
in the broader conversation about where the government's
resources go.
And so that's obviously something that we're very
deeply engaged in.
It is part of the fight, not just on elder abuse but on
education, on healthcare, broadly speaking on the kinds of
investments that we're trying to make in order to build and grow
the economy.
And so these questions are connected.
And this is another area where this partnership is important.
In order to advance these incredibly important priorities,
we have to be successful in the debate on the budget.
Kathy Greenlee: What about -- I know there are several over
here on this side.
So Carol?
Pick someone who looks articulate,
ready for a good question.
Charlie Sabatino: Good morning.
Charlie Sabatino, Director of the Commission on Law and Aging
at the American Bar Association.
One of the practices that we now know makes a positive difference
for seniors is advanced care plan,
especially for seniors with advanced care needs,
and especially if done at the primary care level on a
recurring basis.
It ensures peoples' wishes are known and followed.
It avoids care that's unwanted and often very costly.
And it improves their assessment of the quality of care.
But one of the casualties in the debate over the Affordable Care
Act was the coverage of voluntary advanced care planning
because of the hysteria over death panels.
And there was some hope that it would be included in the
regulations for the annual wellness exam.
But that faltered also.
So my question is this.
What are the prospects for enhancing advanced care planning
for seniors under Medicare in the future?
Kathy Greenlee: Jon, could I broaden this a bit and talk
about this as a financing question in terms of payment but
also the policy question of the broader conversation about how
we continue to support seniors in their own planning which is
something that the aging network can also partner with CMS to do?
Jonathan Blum: I think from our perspective,
our goal is really to make sure that patients have much stronger
relationships with their physicians,
that there is more time to make sure that physicians are
understanding their beneficiary's needs and desires.
And so from my perspective, the Affordable Care Act really puts
in place a lot more time and ability for physicians to have
much stronger relationships, particularly primary care,
with their patients.
So everything that we're trying to do,
kind of in the wonky payment reform,
a notion would be ACOs or medical homes or other kinds of
payment changes, really to our mind is about making sure that
patients have much stronger relationships with their own
physicians, they have more time, they have more knowledge to how
patients want to receive their care.
And to me, this is the best way to ensure that the program is as
strong as possible, not just from a trust fund financing
perspective, but more important, for how beneficiaries receive
their care.
Jim Firman: This is an example of something that
shouldn't just be left up to government,
that individuals in the private sector, nonprofit organizations,
need to make their views known.
Fundamentally it's a no-brainer that every person on Medicare
should fill out an advanced directive.
Even if you say I want everything that's possible to
give to me -- which is one extreme -- make your
wishes known.
The point is, if you are not explicit,
you will eventually find yourself in a situation where
somebody other than you is deciding what care you get and
don't get.
So we at NCOA are proud to be part of a Coalition for Advanced
Care that many leading groups are part of because we in the
private sector need to get the word out through our network,
and everybody listening today should realize this is something
you should do for yourself and for your family,
whatever your preferences are.
Kathy Greenlee: Sandy, did you have anything?
Sandy Markwood: Kathy, thank you.
I think that, as you said, I think right now the aging
network is -- and one of the benefits of the Affordable Care
Act is the opportunities through care coordination and also the
care transition program to actually serve as that bridge
between the medical community and the individual,
the patient at home.
And recognizing that health care and health decisions don't end
when you walk out of a hospital door,
they don't end when you walk out of the medical office,
and actually trying to have conversations and coaching and
to empower the patient and the caregiver to be able to ask the
physician, the dispatch planner, all of those important questions
that are key and critical to the quality of their health.
Kathy Greenlee: Julie, how are we doing online?
Do you have -- okay.
Julie: This question came in through Facebook from Erin,
who said, I'd love to hear more about what HHS is doing under
the Affordable Care Act to ensure quality outcomes for
seniors leaving the hospital and leaving rehabilitative stays in
nursing homes.
There are a lot -- there's a lot that can be done to reduce
readmissions, preventable infections, and accidents.
Kathy Greenlee: This is a broad question.
I may be able to hand the mic to every single person going down
the line because -- so thank the person, excuse me,
who sent that in on Facebook.
So let me start and turn it over to John and have our partners
weigh in.
When we saw this conversation as the Affordable Care Act was
being debated, the issue about hospital readmission,
the way I characterized it was it was two conversations in one.
One was about payment methodologies,
how do we make sure that there's not a financial incentive for a
hospital to have someone go home prematurely or have a financial
incentive to have them come back in prematurely.
The other half of the conversation was what can we do
to help them once they're home.
And it's been on that part that we have been focused through the
Administration on Aging since the Affordable Care Act passed.
We saw the Community Care Transitions program that's
coming to the Center for Innovations out of CMS to be a
tremendous opportunity for the Aging Services Network.
We have a process now or an opportunity now to take good
evidence, good practice on care transitions,
and implement it around the nation and find the right type
of partnership between the medical community and the
community providers who have been doing similar work for
decades, which is how best to help someone stay home and get
the supports that they need.
So we have been working to work with our network to learn
evidence-based practices, to encourage them to participate
and seek funding opportunities from CMS and really be able to
highlight that that's a special and very fragile time for
individuals, for seniors, when they move from one setting to
another, particularly from a hospital to home,
or from a hospital to a nursing home,
and that we all can be there collectively to find a better
way to support them.
There will be people who need more,
need medical supports at home as well.
Certainly the community I think has a large role to play,
and we've been excited by the opportunities that the
Affordable Care Act has brought us the last two years.
So John.
John Blum: The first thing that we know is that quality
varies tremendously across the country,
and that different beneficiaries have different experiences with
the health care system, depending on which part of the
country that they live in.
So part of our work and our goal is to make sure that we elevate
the overall quality of care throughout the country and to
ensure that all Medicare beneficiaries have the best
possible care, no matter where they live.
We know that some beneficiaries have very complicated conditions
and have to use the hospital frequently,
and the Affordable Care Act is nothing to take away those needs
and those benefits.
But at the same time we also know that many beneficiaries
prefer not to have to go back to the hospital,
not to have to go back into the nursing home,
to stay in their home, to stay in their community.
We know that some systems, you know,
transition beneficiaries much better than others.
So the first thing that we're doing is to post data to make
sure that we have the information transparent to
everybody in the country so they can see how their local
hospitals fare, how their local health care systems fare,
to spur the conversation, what does it take to keep
beneficiaries home longer periods of time and in safer
care transitions.
Over time we're also shifting that data to payment incentives
so hospitals that do a better job will have
higher reimbursement.
We're really incentivizing the system to really take care of
patients, to understand what they need,
to understand what they prefer, and have payment incentives tied
to those results.
So really to our work, the Affordable Care's work,
is that in order to keep the program strong,
to keep it working best for beneficiaries,
we have to elevate the quality.
Part of that is to better manage the care transitions for
beneficiaries, and that's a part will come from better data,
more transparency, but also paying for results.
Jim Firman: I think this is another example of
how the innovations from the Affordable Care Act will
lead to better care.
Speaking on behalf of, you know, many of the hundreds of
thousands of community organizations we work with,
they're particularly excited about the provisions because
under the system Medicare will be paying for the right thing,
which is to keep people from coming back to the hospital.
And when, we know about when people are discharged from the
hospital and they wind up coming back,
it's usually because they're dehydrated or they're not eating
properly or they're not taking their medicine or they fall.
And those are all things that we know.
Community organizations, by working in partnership with
hospitals, can figure out effective strategies.
So I think this is going to be one of the things over the next
few years that's really going to show up in the quality of care
for older adults.
Many fewer of them will be readmitted to hospitals when
they don't need to be.
Sandy Markwood: Well, and in saying that,
with the 3026 section of the Affordable Care Act and the
funding announcements that have come out,
I really think that the aging network has stepped up and shown
that they want to be partners with the medical community.
And in looking at that, making those partnerships broader than
just the hospitals, bringing in physician groups,
bringing in the pharmacies, and recognizing that there's a
whole cadre of medical systems experts who can come into play,
but again, focusing on what you said, Kathy,
is that it's also the home and community-based service
delivery system.
When you look at those one in five Medicare beneficiaries who
return to the hospital for a preventable readmission,
the research shows that 40 to 50 percent of those readmissions
are not due because of lack of medical care,
it's because they don't have access to those key
and critical home and community-based services.
So Jim, like you said, how do you make sure that somebody gets
that assessment, they get that meal,
they get transportation for that follow-up doctor's visit,
they get chore services, they get those critical things that
really can make a difference.
And I think in just less than a year,
what we're finding through those program announcements is that we
are bending those -- that readmission, and five percent,
15 percent, and that translates into dollars.
But as importantly for those older adults and their
caregivers, that translates to quality of life.
Kathy Greenlee: So Louise, since we're down there at your
end of the table, are there questions that have come up
along the same kind of topic with your members?
Because there was so much conversation about hospital
discharge and readmission, I'm wondering if there are more
things along that line that you all would have comments or
questions about.
Dr. Louise Chang: Well, there were comments,
there have been comments about frustrations in being discharged
and, say, not being able to get the prescriptions filled,
you know, upon discharge, or a delay in getting that kind of
care, support at home and that kind of thing.
You know, with, it's not like in the olden days where your family
was immediately, always, you always had family around,
the support networks have changed now.
You might have your adult children living far away from
you, and so there's definitely been discussions about that kind
of frustration.
But it sounds like, you know, a coordinated effort's really
involved, and dialogue between the medical community,
social work, and other agencies, in addition to the patient and
their, you know, through the support network will
benefit the most.
Kathy Greenlee: Let me go back to the audience because
over here it seemed like we had quite a few questions,
and then I won't forget the people over here on my right.
Camille Browne: Thanks.
My name is Camille, and I'm from OWL.
And I have a question --
Kathy Greenlee: Will you say your name
again so people know it?
Camille Browne: Camille Browne, and I'm from OWL.
Kathy Greenlee: Older Women's League.
I just want to make sure everyone online knows.
We're all know what this league is, so thank you.
Camille Browne: I'm from OWL, and my question has to do with
the expanding workforce, health care workforce.
In terms of geriatric care physicians and other health care
workers, does the Affordable Care Act contain any funding to
train new physicians to address the needs of midlife and older
women and just the older population in general, because,
as you all know, the older population is growing.
Kathy Greenlee: Yes, the Affordable Care Act does
designate money specifically for geriatric education centers.
It's our sister agency, HRSA, the Health Resources Service
Administration, which is the sister agency to both ACL and
CMS over the Department of Health and Human Services that
was specifically designated money as a part of the
Affordable Care Act to do outreach on geriatric education,
both in geriatric education centers,
as well as to talk about geriatrics to a broader
provider population.
I don't know if, it's not something that John and I,
either one, do directly, but that has been the primary lead
agency within Health and Human Services.
Jim Firman: I also know that the Affordable Care Act beefs up
training for community health workers and other provisions,
recognizing that the health care system of the future is in
addition to better trained physicians,
it's more community-based providers who understand how to
coordinate care and help people stay healthy.
So this helps to position the workforce.
For example, there's a prediction that we're going to
need two million jobs in the home care field over the next
ten to 15 years, and so making sure that we're training people,
including older adults who can be very good workers in this
field, is one of our priorities as well.
Cecilia Muñoz: Just to build on that,
the Administration's commitment to community health centers both
under the Affordable Care Act but also under the Recovery Act
before it, has already expanded community health centers'
capacity by three million people that they -- an additional three
million people that they're able to serve each year,
and we've just made another series of grants to expand the
population served by over another million.
And in many cases this means actually physically expanding
the facilities of the community health centers.
So that's, Jim is absolutely right,
that this is a big part of the commitment to our sort of vision
for care, is to make sure that we're really maximizing and,
you know, not just people's coverage,
but the actual availability to care,
particularly in harder to serve communities.
Sandy Markwood: Well, and in following up on that,
because of the expansion of the community health centers,
more and more, and, Kathy, you and the regional offices have
been working on this, is again, bringing the together the
community health centers with the aging network.
And the opportunities there to then broaden that scope
and reach to older adults at the community level and
their caregivers.
Kathy Greenlee: So if I can connect this back up to
Camille's question, you can see that it's all interrelated.
That there are opportunities through HRSA kind of on the
private side, so to speak, through educational
opportunities, educational partners, universities,
geriatric education centers.
But also we know through the community health centers that
they're serving an increasing older population,
and for the first time this year,
HRSA has a contract in place to provide technical assistance to
the federally qualified health centers about serving
an older population.
So as this very well informed audience would know,
there are times that we need to focus specifically on additional
geriatrics in terms of training, but also we need to talk to the
providers who are seeing increasing numbers of seniors
and make sure that they also receive competencies and
training in the field of aging as well.
And I think we've had the opportunity through the
Affordable Care Act both in kind of the federally qualified
centers and the geriatric education centers to kind of
reach this from both directions.
Other questions.
I think, let me go over here because I know there's --
Rich Wahlberg: Yes, hi.
Good morning.
My name is Rich Wahlberg, (phonetic)
I'm the Administrator of Mineral Park Center for Senior Living in
Beachwood, Cleveland, Ohio.
Very honored to be here today.
Mineral Park is one of the largest senior care communities,
nonprofit faith based, in the United States,
and we're also a five star Medicare
rated facility.
I want to share a positive compliment about the Affordable
Care Act and then shoot to my question.
I always think it's always good when you get in front of a group
to share about how the Affordable Care Act touches the
needs of the human beings, the individuals.
I spoke on Friday, I told one of the ladies we served who's an
outpatient therapy client, 58 years of age, disabled,
on Medicare.
Her husband back in 2009 died of a heart attack,
her son was killed tragically in a car accident.
And we see her for outpatient therapy,
and she said to me when I spoke to her on Friday,
told her about this conference today,
the town hall -- and the question I'll get to in a second
-- she said, Mr. Wahlberg, before the Affordable Care Act I
was spending $500 a month on my medications and I couldn't put
food on my table.
And I would cut my heart pills, my depression pills,
my diabetes pills, my asthma medication,
I would take it every three, four days.
I would hold back, you know, at the end of the month because
I couldn't afford food on my table and to pay my rent.
And she said after the Affordable Care Act the special
thing is it went down to $200 a month,
and she could now afford food on the table.
Back in 2010 she got that rebate in 2010 through the Act.
So she really wanted to express appreciation.
I just always think it's nice to share a special story,
as a provider who touches about 1400 elderly and disabled people
a day in Cleveland, Ohio.
My question which she was raising and other folks in our
campus and throughout the country is raising is through
the Act somebody like this would benefit through case
management services.
Of course, seeing under the wellness benefit a doctor once a
year or so, but a nurse or social worker who she could call
on once, twice, three, four, five times a year through like a
Medicare home health benefit to help tie together her medication
issues, her food issues, her medical issues.
And I'm wondering through the Affordable Care Act whether
that's being considered to be expanded,
the services of a -- limited services on a regular basis of a
case manager type person under Medicare or if it's something
that you're going to be looking at in the future.
Thank you.
John Blum: Well, I think one of the things that we know
is that when care is better coordinated,
when care is better quality, that it's a very frequent touch
that beneficiaries have with their care provider,
not necessarily their physician, but a nurse practitioner working
in the physician's office, or a kind of a community
outreach person to make sure the beneficiary's taking his or her
medication, that he or she has enough food to keep
them healthy.
We know that when beneficiaries follow their medication regimes,
they stay healthier for longer periods of time when they have
sufficient food.
So we're doing a lot of different strategies to ensure
that we have that much more frequent touch
with beneficiaries.
One strategy is to build stronger medical homes where we
can, you know, have not just a primary care physician,
but an entire team identifying beneficiaries who are in the
most fragile condition that can use, you know,
more frequent contact with their care provider.
For example, for beneficiaries who have a high rate going back
to the hospital, we want health plans and care providers to
actively outreach to those beneficiaries to make sure they
have everything in their home to keep them safe and healthy.
And they don't have a risk of falling, for example.
So it's not just one benefit, but a whole host of different
strategies to make sure their health care system is much more
responsive to those day-to-day needs and to identify
beneficiaries early so it's not when they come to the hospital
that the care intervention starts.
Kathy Greenlee: Thank you.
More questions.
I want to make sure we get to as many in the audience
as possible.
Rachel Goldberg: Hello, my name is Rachel Goldberg,
I'm from B'nai B'rith International,
and I think everyone here probably recognizes a
fundamental truth, which is that healthy aging can't
realistically start at age 65.
I know there were efforts in the Affordable Care Act to address
what we see, which is lots of people between let's say 55 and
65 who are unemployed, underemployed,
uninsured or underinsured for one reason or another,
and insurance in the private market has historically been
inaccessible or unaffordable or astronomically expensive.
I wanted to know how the efforts in the Affordable Care
Act to address that, how things are going.
Kathy Greenlee: Do you want to do it or --
Cecilia Muñoz: Yeah, I mean, sort of broadly speaking,
this was one of the points.
When the Affordable Care Act comes online in 2014 the goal is
for people to have access to affordable care through the
exchanges that are coming online.
So we are, you know, working full tilt with the states that
are setting up exchanges, and as I'm sure you know,
in the case of a state which doesn't set up a health care
exchange the federal government will have an exchange available.
But the idea is to maximize access for everybody across the
country in the system to make sure that they have coverage,
to make sure that it's affordable,
and then to make sure that this panoply of protections that
we've talked about with respect to preventive care,
with respect to not having lifetime limits,
with respect to coverage if you have a pre-existing condition.
Right now, for example, children with pre-existing conditions can
get access to coverage, and by 2014 that will be true
of adults as well.
Insurers won't be able to discriminate against them.
All of that will be in place by 2014 for the very population of
which you speak.
Jim Firman: A few points.
Yes, we absolutely agree, getting care to people before
they're on Medicare is essential for keeping people healthy.
But there's this sort of myth that seniors only care about
themselves, and I think one of the things we're hearing is that
seniors are seeing the benefits of the Affordable Care Act in
the coverage for their grandchildren.
You know, I have two children in their 20's with serious health
issues who would not have been covered if it wasn't for the
changes in the Affordable Care Act.
And so grandparents are seeing the benefits of coverage for
their grandchildren now, and then maybe many of their
children will see when some of the new provisions come in the
exchange act.
So this is a family -- a law that affects not just older
people but entire families.
Kathy Greenlee: I just want to,
I'm going to ask for more question,
just to acknowledge -- and this has come up in a
couple of the questions, when we talk about Medicare,
we generally talk about seniors, but there are millions of people
who are not seniors, younger people with disabilities who are
also accessing Medicare, and the benefits in the
Affordable Care Act are available to anyone on Medicare.
So the preventative services benefits.
Someone over here talked about someone who was 58 on Medicare,
that all these benefits are a Medicare benefit,
not a senior benefit, and so they can apply equally to a
younger disabled population that very much needs this benefit.
Yes, let's go down to the -- Carol,
can you get -- I'm not going to forget you over here.
Joseph Fasali: Yes, good morning.
My name is Joseph Fasali, (phonetic)
and I'm the Director of Higher Education in Health IT
Implementation, Political Consortium of Historical Black
Colleges and Universities and Metro Data.
One of the questions -- I have two questions, basically.
Primarily is that I work with providers and seniors in
hard-to-serve communities, especially around the
communities of historical black colleges,
and one of the things that we are finding is that when the
five-year plan in the annual wellness visit is built for
seniors, many of the seniors don't understand that plan,
and they're left with a plan that they're not executing
because they don't understand the plan.
The question is how can we continue to do the work with
seniors once that five-year plan is built to make sure that they
connect with a physician or to make sure that the follow-up is
done, because many of our seniors do not have access to
physicians, they don't go to the physicians if they do have
access, and so they don't really do a whole lot in that program.
So when we go out we make sure that we don't only tell them
about the annual wellness, but we bring the medical
community to perform the annual wellness visit.
And the second question I have is the worst question in my
mind: How will the Supreme Court decision impact seniors based on
where we are today or do we have to reeducate all over again?
Kathy Greenlee: Let's start with Cecilia on the second
question, and then maybe both Jim and Sandy and John on the
outreach question.
Cecilia Muñoz: So we continue to believe that we are on a very
strong legal footing with respect to the Affordable Care
Act, so we are continuing, you know,
we're working very hard every day to implement this law and we
are, you know, on schedule, on track for full implementation
by 2014.
So our assumption is we're going to go forward, and we're doing,
you know, believe me when I tell you we have a lot on our plate
every day to make sure that that happens.
I will say that the implications of, you know, just in general,
this is just, you know, empirically true,
the implications if the Affordable Care Act were to go
away have to do with all these protections that we're
talking about.
Access to preventive care, protections for people with
pre-existing conditions.
Young people being able to remain on their parents' plans
until the age of 26.
All of those protections are tremendously important,
tremendously popular, and most of them in place now and
affecting people by the millions.
Now, you know, the provisions with respect to the doughnut
hole, the rebates to seniors for their prescription drugs,
these are terribly important to people's lives now.
And so just as we have this conversation and we continue
this conversation about the Affordable Care Act, again,
it's important that people understand this is what's at
stake here.
This is what we have already won for the American people,
for seniors around this country.
Now, and this administration is deeply committed to them.
Kathy Greenlee: So Jim, just a reminder of
the first question.
So seniors take advantage of the wellness visit, get a plan,
how do we make sure that they have the support to
follow through?
Jim Firman: Well, one of the provisions of the law,
provisions that we really are excited about is the emphasis of
the law on promoting evidence-based self-management.
It's a recognition that the future of health care is in part
what doctors tell you to do, but it's more about how well
patients become empowered to be active patients, to eat right,
to take the right medications at the right time,
to exercise properly, and to not -- and to quit smoking if
they do that.
And this law has great provisions promoting
evidence-based self-management programs.
For example, we've worked with community organizations
throughout the country, the Administration on Aging and
Sandy's group to help over a hundred thousand people learn
basic self-management skills.
And let me give you one vignette of a Joe, Joe,
Jose Kedding (phonetic)
from Maui, Hawaii, who recently had a severe stroke,
actually November 2010, and his quality of life was terrible and
he really had no hope for the future.
Prior to his stroke he didn't take his medications that had
been prescribed, he never questioned his doctors,
and he didn't pay attention to his diet.
But then he enrolled in a community workshop series called
Better Choices Better Health, and he realized that he was
taking medications that were working against each other and
that he was getting incorrect advice from some of his doctors.
So he credits this program with teaching him how to cope with
the challenges he was facing to better manage his health.
His life Laura claims that the program,
thanks the program for giving her man back,
the man she had married for 40 years.
So what this is about is we have to recognize that the future of
health care is encouraging, empowering older adults to
take charge.
It may be less of a problem for baby boomers,
because we're used to wanting to be in charge,
but people have to take over their health and realize they're
at the center of managing their health care,
and then make sure the doctors and other people can help them.
This is a fundamental shift that HHS has recognized as a key to
meet for people with multiple chronic conditions,
and I think this is something that the Affordable Care Act is
really pushing forward rapidly.
Over a hundred thousand people were helped in the last 18
months, and we hope to scale that to millions in
the next few years.
Kathy Greenlee: Thank you.
I keep promising this group I'm coming back over here.
So let me -- they're fighting over there.
Stand together and ask them in unison.
Dennis Streets: There we go.
Good morning.
I'm Dennis Streets, and I'm Director of the North Carolina
Division of Aging and Adult Services.
First of all, I just wanted to echo the earlier comments about
the importance of addressing the elder abuse,
particularly Adult Protective Services.
My question really, though, is I'm excited from North Carolina
in being able to be among those working back with CMS around
improving the care of the persons who are dually eligible
for Medicare and Medicaid.
And we've talked about the importance of the health care
home, the chronic disease self-management,
the home and community services, and so on,
and transitional care.
Two other areas I wonder if you could comment a little bit
about, and one is the behavioral mental health as well as health
technology, and what part they may play.
John Blum: I think one area that we're working very hard
this year, working with states, is ways to better integrate the
care for those beneficiaries who are eligible for both the
Medicare and Medicaid programs.
If you think about the current health care system
is very siloed.
We have hospitals, we have physicians,
we have nursing homes, and one goal is to bring that into more
of a seamless system.
The same is true or more true for those who are eligible for
both Medicare and Medicaid.
And our goal is to make sure those beneficiaries working with
states have a much more integrated and seamless benefit
set that includes the hospital-physician benefits,
prescriptions, long-term care, and behavioral health.
And right now many beneficiaries who fall into this group have
several benefit cards, they have to navigate very complicated
rules between Medicare and Medicaid,
it doesn't make sense for the health care system to -- it
doesn't make sense for the beneficiary.
So working with states we're putting into place new models
that will really create this seamless benefit package,
to make sure that the caregivers and beneficiaries can make smart
decisions for what's in the best interests of the beneficiary,
not just what the silos of care will pay for.
But going to your second question about health IT.
Really, this is an area that we think the entire health care
system needs more information, beneficiaries need more
information, providers need more information.
We know that quality, again, varies dramatically by part of
the country, cost varies, who beneficiaries are that could
benefit more from just a more active home-based approach,
so data is crucial to all of that,
making sure that pharmacy interactions are best managed.
So our health care system, you probably know better than
anyone, has been, you know, been hindered by a lack of data
information that's now changing to make sure that we're sharing
our data with the care -- with the care providers and making
all this information much more transparent so we can seek
care improvements.
Kathy Greenlee: Let me check in with Julie and see how we're
doing online.
I have a fear you're having dozens and dozens of questions.
Julie: We have some questions.
So the first one comes from Twitter,
and it says can you address efforts to make insurance more
affordable for people over 50?
Kathy Greenlee: We touched on that a little bit.
Do you all have anything else that we need to talk about?
We talked about the exchanges, I don't if there's --
Cecilia Muñoz: Yeah, I mean, I think that's the fundamental
goal here is for folks of any age range to be able to
participate in the system, to be able to have access to insurance
that's affordable.
That's really what's going to be in place when these exchanges
come online.
And you can get a taste, at least for what it's going to
feel like to use the system to get into an exchange by going on, which what that does right now is aggregate
what's available to you.
If you're in the market for health insurance now,
it gives you for the first time the basis to make sort of an
apples-to-apples comparison between plans without having to
sort of do all the research yourself and go finding out what
each plan has to offer and sort of figure out how to assess,
you know, this one has a higher deductible but this one has
these co-pays, like what's going to work out the best for me
in the end. is actually a very powerful way to help you
just assess what your needs are, put in information about your
circumstances, and then get a sense of what your options are.
And of course again once we're on the other side of 2014 and we
have the exchanges available, you'll have that kind of system,
but ultimately the options will be better and ultimately we're
driving the cost curve down so that the whole point of this is
to make sure that health care is both accessible and affordable
and that the protections that we've talked about are available
to everyone in this country of any age.
Kathy Greenlee: Dr. Chang, can I go to you next,
and then I'm going to come back over on this side.
Carol, I'll come back to you.
Dr. Louise Chang: Sure.
Just to build on that, the last question,
so for beneficiaries with low to moderate income,
who may have Medicare, private health insurance,
but still have high out-of-pocket costs,
in the meantime understanding that the doughnut hole is
closing, the gap is closing, how, what can they do now?
Kathy Greenlee: Do you want to talk about that?
John Blum: I think a couple of things.
One is that we through our CMS website, for example,
help beneficiaries identify how to get lower cost
prescription drugs.
For example, when they can safely substitute a brand name
drug for a generic, in order to have that conversation with
their physician.
So really what we want to do is to provide more information to
help beneficiaries understand there are the new benefits that
work to lower their costs, and also know that from our
perspective that we're trying to keep the overall costs growth
rate low for the Medicare program,
which preserves the program but it also lowers premiums,
cost sharing for beneficiaries.
But for those beneficiaries who feel they're having difficulty
paying for their benefits today, they should call the toll-free
numbers that we operate, 1-800-Medicare, for example,
or those, for other partners, because chances are there are
programs that exist to help beneficiaries save money.
Kathy Greenlee: Sandy, do you, let me go to Sandy,
if I can, Jim, just --
Sandy Markwood: Well, in saying that,
I think that through the state health insurance programs and
the area agencies on aging are really helping to ensure that
people get connected to the right Medicare Part D plans,
and also, again, and I know, Jim,
I want to turn to you because in looking at assessing people and
for all of their benefits needs, because generally if somebody
can't make their Medicare payments and benefits,
there are other things that they can't make the benefits to,
as well.
And looking at the local level, working through the
area agencies on aging, the providers, and Jim,
you need to talk about the benefits checkup program,
is finding out what people qualify for and then making
sure, just knowing what you qualify for is usually
not enough.
You really need to help walk people through actually applying
for the benefits that they need and can receive.
Kathy Greenlee: Jim, will you do benefits checkup briefly,
I want to try to get a couple more questions in,
but this is an important program that you have, so I --
Jim Firman: Yeah, so, the bottom line is that people,
older adults are missing out on $25 billion a year of
free benefits.
The Medicare limited income subsidy,
which pays for 95 percent of your drug costs if you need it.
The Medicare savings program which increases your Social
Security check by $100 a month, plus coverage of co-pays and
deductibles, and then the supplemental nutrition and
assistance program which on average provides $119 a month to
seniors to pay for food, and only one out of three seniors
who are eligible for it are getting it.
So if people are in need they can go to,
that's a website supported by the federal government and by
private sources, and it's a one-stop shop, confidential,
fast and free, to learn about all the benefits you're
eligible for.
But if you know seniors who are hurting, as Sandy said,
there probably is a solution, we're just not connecting
people to them.
Kathy Greenlee: Thank you.
Back over on this side.
Anita Rosen: Hi, I'm Anita Rosen from the American Society
on Aging, and I'd just like to follow up on something was
mentioned a little earlier, and that had to do with
behavioral health.
Depression, anxiety are very costly for the elderly,
for them individually, for their families and caregivers,
and for Medicare.
And I'm really pleased with your comments about costs and
prevention and about integrated care.
Just wondering what specifically do you see as some incentives to
really encourage preventative, early intervention,
and work around such things as depression and anxiety to really
help the system and help individuals.
John Blum: We talked about the annual wellness visit,
which is just one area, but really if you think about it,
this is a chance for a beneficiary to have a
conversation with his or her physician,
really to go over not just the current medical needs but the
entire care picture for that beneficiary.
One area is the overall mental health of the patient,
if the patient needs nonmedical services that could benefit to
keep them healthier for longer periods of time,
to keep them in the community.
But really what we're trying to promote throughout the Medicare
program is this frequent conversation with the health
care delivery system, behavior be it behavioral health,
be it medical intervention, be it just primary care checkup
services, just, because we know that when we can treat
conditions early, when we can prevent conditions early,
that it works well for the Medicare program,
but a bit more important, that it works better
for beneficiaries.
And our goal is to transition from a program that just pays
for care when people are sick to paying for them before they
become sick.
Before ill, to catch chronic conditions early to ensure that
beneficiaries are treated better,
but also that serves the long-term interests of
the program.
Kathy Greenlee: We probably have time
for one final question.
And so I don't know which -- I think I'm going to go over here
just because I see more hands.
Sorry, folks.
So Carol, if we could find one more,
I want to make sure we give people on the panel
time to respond.
Carol Peckham: Hi, I'm Carol Peckham, and I'm with Medscape,
which is the sibling of WebMD, and my colleague Dr. Chang I
think had mentioned the problem with finding primary care
physicians, and I'm the editorial director of the
primary care sites at Medscape, and one of the major problems I
think facing the Affordable Care Act is the resentment of
many physicians.
They feel that they're being overburdened,
and the main problem with primary care is lack
of reimbursement.
And I know this isn't really your role,
but I wonder if you could address the problem of primary
care docs not being paid for cognitive, cognition,
rather than most of the money going to the specialists
for procedures.
John Blum: Well, there are a couple of things that the
Affordable Care Act did to address this issue.
One is to provide higher payments,
higher reimbursements for primary care physicians
providing primary care services.
But when you think about the changes that we've been talking
about, it really elevates and makes the primary care physician
and the primary care team sort of the quarterback of
beneficiaries, of health care through various changes like
medical homes, but the accountable care organizations,
prevention, wellness, are really changing how we think about
paying for care from just paying for when beneficiaries become
sick to keeping them healthy, to keeping them, you know,
much more frequently tied to the physician's office.
So to my mind, you know, there are direct reimbursement
increases, but more important is a change to how we organize the
overall delivery of care, putting prime primary care homes
as sort of a centerpiece to that care design,
but to make sure the primary care physician,
the primary care team is first and foremost to how Medicare
beneficiaries receive their care.
Kathy Greenlee: Well, it's good news and bad news.
We have more questions; we can't answer them all.
So we hope that you will attempt to stay engaged with us so that
we can make sure if you have a question that we need to answer
that we can or will.
I do want to take a moment before we leave to thank the
panelists that we've had a chance to meet today.
Louise Chang with WebMD and Sandy Markwood with the National
Association of Area Agencies on Aging.
Jim Firman with the National Council on Aging,
also the chair of the Leadership Council on Aging Organizations.
My friend John Blum with CMS who gets lots of the Medicare
questions, and Cecilia Muñoz.
Cecilia, I didn't know if you had any final comment from the
White House.
We are so glad you were with us today from the Domestic
Policy Council.
Cecilia Muñoz: Thank you so much, Kathy.
I'd also like to add my thanks to all of the panelists,
and really to all of you for coming and being part of
this event.
You know, this last question with respect to physicians and
primary care physicians in particular reminded me,
we did an event like this actually with physicians just
about a week ago.
We're doing an event with nurses,
we did an event focused on women,
and this has been part of really a continual effort to make sure
that we're focusing on every constituency with a stake in the
Affordable Care Act, we've done that really throughout the
process really since before the law was passed,
and those efforts and the kinds of comments and questions that
you have, I mean, I can't say strongly enough how much that
informs our work and how enormously valuable it is to us
to make sure that we do the best possible job in moving this law
forward to make sure that we're providing the protections that
we intended to provide to people.
This is an immense, complex effort,
and at the end of the day the proof in the pudding is going to
be on its impact on people's lives.
And so we just very much value and appreciate the time that
you've spent to help inform us.
We're going to keep that conversation going.
We have a lot to do going forward.
So really, thank you very much.
Kathy Greenlee: Thank you.
Now for those of you here, if you could look at,
if you picked up this little card before you came in,
I wanted to just direct your attention and tell people online
what we're pointing to.
These are the opportunities for you to stay connected and
involved with us.
That you can go to Facebook at White House,
White House has a Facebook page.
You can follow us on Twitter and the handles on Twitter are
@WhiteHouse or
If you're interested in e-mail updates, updates.
And Cecilia had mentioned the website,
which has a lot of information on there about
the Affordable Care Act as well as kind of individual issues
that can be more tailored to a specific person.
So I would encourage you all to stay involved with us,
and I would like to end where I began and talk about
seniors themselves.
That one of the great honors serving as Assistant Secretary
for Aging is you have the opportunity to go talk directly
to seniors.
Seniors are their own best advocates,
and for all of us who work on their behalf,
I would just encourage us to stay connected to the seniors.
They still have questions about the law,
they still have opportunities under the law to get their
doughnut hole checked or to get their preventive benefits,
and it's important that we stay engaged with seniors so they
take advantage of all that we have provided, really,
through the Affordable Care Act for them.
It's about their health, and those of us know seniors,
that what seniors want most is to stay healthy and stay
independent, and this law can help them do both.
So thank you all very much for coming this morning,
it was wonderful to have you here.