In its Fall, 2011 newsletter, Take Care!, the National Family Caregivers Association (NFCA), a non-profit association working to support family caregivers, has published a thoughtful editorial entitled: “Family Caregivers and the Affordable Care Act: Where the Action Is.”
In this editorial, NFCA describes and calls for family caregivers to take action in support of some of the innovative programs being tested and developed by the Center for Medicare and Medicaid Innovation to improve health care delivery for chronic health conditions. Chronic health conditions, such as diabetes, high blood pressure, arthritis & osteoporosis, and Alzheimer’s disease, are the types of conditions requiring daily management and care that family caregivers for the elderly deal with every day.
As explained in the NFCA editorial, the U.S. acute care pay-for-procedures health care system is not presently geared fully to cover proper long-term care of these chronic conditions.
The Center for Medicare and Medicaid Innovation (the “Medicare Innovation Center”) was established within the Centers for Medicare & Medicaid Services (CMS) by the health reform law of 2010, the Patient Protection and Affordable Care Act (the “Affordable Care Act”).
Among the innovative new programs being tested by the Medicare Innovation Center are the following, which were specifically mandated in the Affordable Care Act:
- Sec. 3024 Independence at Home (IAH) Demonstration Program. As described in the Affordable Care Act itself, this is “a demonstration program . . . to test a payment incentive and service delivery model that utilizes physician and nurse practitioner directed home-based primary care teams designed to reduce expenditures and improve health outcomes in the provision of items and services under this title to applicable beneficiaries.” Authorities and many family caregivers have long said that doctors and health care providers visiting and providing care for frail seniors at home will provide demonstrably improved care at lower cost, with fewer needless hospitalizations. This program is designed to test and help bring this about.
- Sec. 3026 Community-Based Care Transitions Program. This is a program designed to provide better transition of care after hospital discharge for certain at-risk Medicare beneficiaries, who currently suffer an unacceptably high rate of hospital re-admissions for complications that could have been prevented by better transition of care after discharge from the hospital. As stated in Section 3026 of the Affordable Care Act, “The Secretary [of HHS] shall establish a Community-Based Care Transitions Program under which the Secretary provides funding to eligible entities that furnish improved care transition services to high-risk Medicare beneficiaries.” The high-risk Medicare beneficiaries who may benefit from this program are defined in the law to include those with cognitive impairment, depression, a history of multiple readmissions, or any other chronic disease or risk factor determined by the Secretary of HHS. Obviously, this is a program that will benefit most seniors and their family caregivers.
- Sec. 3502 Establishing Community Health Teams to Support the Patient-Centered Medical Home. This section of the Affordable Care Act required the Secretary of HHS to provide grants to assist primary practices and other qualified local care providers to enter into contracts with other providers to improve the coordination of care and provision of preventive care services to persons with chronic conditions. Improved coordination of care is a crying need of our current health care system, as any family caregiver knows from frustrating experience in being required to step in and try to coordinate and manage care among different doctors and medical and long-term care providers who currently “don’t talk to each other.” Consequently, but for the family caregiver’s intervention, our current fragmented system can and does place frail seniors at risk.
- Sec. 3503 Medication Management Services in Treatment of Chronic Disease. Section 3503 of the Affordable Care Act provides in part, “The Secretary [of HHS], acting through the Patient Safety Research Center established in section 933 . . . shall establish a program to provide grants or contracts to eligible entities to implement medication management . . . services provided by licensed pharmacists, as a collaborative, multidisciplinary, inter-professional approach to the treatment of chronic diseases for targeted individuals, to improve the quality of care and reduce overall cost in the treatment of such diseases.” The “targeted individuals” eligible to benefit from these medication management services include individuals who:
- “take 4 or more prescribed medications (including over-the-counter medications and dietary supplements);
- take any `high risk’ medications;
- have 2 or more chronic diseases, as identified by the Secretary; or
- have undergone a transition of care, or other factors, as determined by the Secretary, that are likely to create a high risk of medication-related problems.
Again, obviously, seniors and their family caregivers stand to benefit from this innovative program.
All of these programs being developed by the Medicare Innovation Center obviously will most benefit seniors with chronic conditions and their family caregivers. Yet, some members of Congress have recently sought to undermine the Medicare Innovation Center and the innovative programs is was charged by the Affordable Care Act with developing, by calling for Congressional investigations into funding for these programs and seeking to de-fund these programs.
In the face of these apparently politically-motivated attacks on the Medicare Innovation Center, the National Family Caregivers Association (NFCA) has called upon family caregivers to speak up and take action in support of the Medicare Innovation Center.
In its editorial, NFCA wrote:
- We need to press for the necessary funding to implement these programs.
- We need to tell our stories about the problems that are created by a lack of good transitions of care, about the difficulties of getting our grandmother to the doctor because she is so frail, about the problems caused by mismatched prescriptions and the lack of holistic care coordination.
- We need to tell our stories to our elected officials and let them know of our availability to share these stories with others.
- We need to educate our doctors so they can better understand our role as a health team member. Doctors need to know that the government wants to hear from family caregivers about our experiences with the healthcare system, not just those of our care recipients. Our elected officials want to know about the quality of care being provided and they are expecting us to weigh in on this and other issues.
The Centers for Medicare & Medicaid Services is jumping into uncharted waters with the creation of the Innovation Center. It is testing new and novel ways to institute change that will have an impact on healthcare quality, safety, and cost. It is striving to fundamentally change the way medicine is practiced in the U.S. and how families living with chronic conditions can live healthier, happier lives. It is our job as family caregivers — indeed, it is in our best interests — to make sure the Innovation Center programs succeed.”
We applaud and second the views of the National Family Caregivers Association (NFCA). We would add that, in the face of the many false “sound bites” being circulated about the Affordable Care Act (which detractors call “Obama Care”), family caregivers need to help circulate the facts and true information about the many benefits being provided to patients and caregivers both by the Medicare Innovation Center and by the Affordable Care Act itself.
Discussion about the Affordable Care Act should not be based on false and misleading sound bites, but rather on an understanding of the actual text of the law itself, or at least on the comprehensive summary of the laws’ provisions and benefits written by the Eleventh Circuit Court of Appeals.
Even though this Court struck down the individual insurance mandate in the law under the Commerce Clause of the U.S. Constitution, nevertheless this Conservative-leaning federal Appeals Court upheld all of the other provisions of the law, and in its lengthy opinion included a very good basic summary of all of the benefits that are actually in the Affordable Care Act.
Discussion should be based on a true and correct understanding of the facts and the law, not on false and misleading sound bites. Family caregivers need to speak up and help circulate the true facts and text of the law and the Eleventh Circuit Court of Appeals opinion itself.
See also the previous HelpingYouCare™ reports on:
- News on Health Care Reform;
- Editorials: What Needs Improvement, With Your Comments;
- Advocacy: Proposals for Reform, With Your Comments;
- Legislation: Pending & Recently Adopted; and
- International Health Care Compare: Information on Health Care & Long-Term Care Solutions in Other Countries.
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