[Congressional Record Volume 146, Number 100 (Thursday, July 27, 2000)]
[Extensions of Remarks]
[Pages E1335-E1336]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page E1335]]
    INTRODUCTION OF THE CHRONIC ILLNESS CARE IMPROVEMENT ACT OF 2000

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Wednesday, July 26, 2000

  Mr. STARK. Mr. Speaker, in our aging society, it is beginning to dawn 
on millions of Americans across the country that chronic illnesses are 
now America's number one health care problem. Yet because our health 
care system has been designed around meeting the needs of acute, not 
chronic illness, our system of services for those with Alzheimer's, 
diabetes, and other major conditions is both fragmented and inadequate.
  To be successful, 21st century health care must be reorganized to 
maximize the intelligent use of those protocols and procedures that can 
most effectively control and slow the rate of chronic illness 
progression. This can only be accomplished if treatment for chronic 
conditions is consciously and carefully integrated across a range of 
professional providers, caregivers and settings.
  This integration of services for chronic illness care is at the heart 
of the Chronic Illness Care Improvement Act of 2000 that I am 
introducing today.
  It is a major bill, designed to focus debate on the need to provide 
comprehensive and coordinated care for people with serious and 
disabling chronic illness. I am introducing this Medicare measure this 
summer to invite comments, ideas and suggestions for refining this bill 
so that it can be re-introduced at the beginning of the 107th Congress, 
with bipartisan sponsorship. The bill I am introducing today is the 
result of months of consultation and work with numerous senior, 
illness, and health policy groups. I hope that it will receive the 
endorsement of many groups in the days to come.
  The bill has four titles and is phased in over a number of years. 
Why? Because we know a lot about the management of chronic illness--but 
in truth, the comprehensive national program that is so desperately 
needed will require long range planning and implementation in phases.
  Therefore, Title I creates a temporary Commission to study and 
recommend solutions to the complex issues involved in coordinating and 
integrating the diversity of healthcare services for the chronically 
ill.
  Title II lays the groundwork for a full, comprehensive care program 
by establishing the databases and infrastructure we will need to 
provide high quality care to those with chronic illness.
  Title III launches two major prototype chronic disease management 
programs-one for diabetes and the other for Alzheimer's disease. Once 
we learn from the experience of these two prototypes, the Act calls for 
expansion to a high quality national program for management of other 
serious and disabling chronic illnesses.
  Title IV promotes coordination of care for dually eligible 
beneficiaries by streamlining the processes of obtaining waivers and 
determining budget neutrality of combined Medicare and Medicaid 
programs.

     Why a Program to Improve the Care of Chronic Illness is Needed

       Do you know someone who has diabetes, high blood pressure 
     or a heart condition? Perhaps someone who is important to you 
     suffers from arthritis, asthma or Alzheimer's disease. All of 
     these problems have one thing in common-they are chronic 
     illnesses. Once these problems begin, they stay with you and 
     many of these problems inevitably progress over time. What 
     most people don't know is that chronic illness is America's 
     highest-cost and fastest growing healthcare problem 
     accounting for 70 percent of our nation's personal healthcare 
     expenditures, 90 percent of all morbidity and 80 percent of 
     all deaths.
       Yet while chronic disease is America's number one 
     healthcare problem, care for those with chronic illness is 
     provided by a fragmented healthcare system that was designed 
     to meet the needs of acute episodes of illness. We cannot 
     deliver 21st century healthcare with a system that was 
     designed a half century ago, before angioplasty or bypass 
     surgery for heart disease and before L-dopa for Parkinson's 
     disease.
       Medical discoveries like these have transformed many 
     illnesses from rapidly disabling conditions to chronic 
     conditions that people live with for a long time. But the 
     healthcare system that works for a devastating heart attack 
     does not work for chronic illnesses that need a totally 
     different group of services, including long range planning, 
     prevention, coordination of care, routine monitoring, 
     education, and self-management.
       The acute care model is a mismatch for the needs of chronic 
     disease and the result is that people with chronic conditions 
     receive healthcare that responds to crises rather than 
     preventing them. The fact is we know a lot about the natural 
     course of chronic illnesses like diabetes and arthritis. We 
     have learned the all-too-common scenarios that result in 
     complications such as an amputation in the diabetic or a 
     stroke in the person with uncontrolled hypertension. Delaying 
     stroke by 5 years would yield an annual cost savings of 15 
     billion dollars, yet we continue to shortchange the ounce of 
     prevention that is worth a pound of cure.
       The patients know what is wrong with the system--they tell 
     us our healthcare system is disjointed and a nightmare to 
     navigate. They want more information about their condition, 
     more emotional support, and more control of their care. They 
     deserve better communication and integration of care amongst 
     their many healthcare providers who currently function to 
     deliver separate and unrelated services, even though they are 
     providing care to the same person.
       But none of this will happen in a medical system that does 
     not reward quality of care for chronic illness. Our 
     healthcare system does not reward preventive care or 
     continuity of care. Neither do we reward early diagnosis, 
     interdisciplinary care, emotional counseling or patient and 
     caregiver education.
       The cornerstone of quality healthcare for chronic illness 
     is long-range planning and prevention, yet the Congressional 
     Budget Office currently has no mechanism to measure cost-
     effectiveness over extended periods of time. Unless we 
     recognize that an upfront investment in the early and middle 
     stages of chronic illness will pay dividends over the long 
     term, we will continue to be caught in the vicious cycle of 
     responding to crises rather than anticipating and preventing 
     them.
       There is increasing recognition of the looming problem of 
     providing long-term care to the growing number of senior 
     citizens, but little awareness that better care of chronic 
     illness beginning at the time of diagnosis is the most 
     effective strategy to prevent the progression of disability 
     and loss of independence. Join me in supporting The Chronic 
     Illness Care Improvement Act of 2000 to bring excellence to 
     the care of chronic illness, just as Medicare has already 
     achieved for acute illness. This legislation will put our 
     emphasis where it belongs--on proactive strategies that will 
     prevent complications and disability before they happen.
       This is a systems problem that requires a systems solution. 
     Disease management of chronic illness will only succeed if 
     financial, administrative and information systems are 
     developed to support it. Our current healthcare system locks 
     into place fragmentation and duplication of services. We must 
     strive to align financial incentives among healthcare 
     providers to achieve common care, quality and cost 
     objectives. We can improve the quality of care while reducing 
     costs by reducing duplicative and unnecessary services and by 
     preventing complications and loss of independence.
       The healthcare challenge of this new century is to design a 
     Medicare system that meets the needs of persons with serious 
     and potentially disabling chronic illness. The medical 
     discoveries of the 20th century have dramatically prolonged 
     the life expectancy of persons with all types of chronic 
     conditions. In the 21st century, our challenge is to reduce 
     the progression of disability and to improve the functional 
     status and quality of life of persons with chronic illness.

                        Invitation for Comments

       Mr. Speaker, reforming our health care delivery system to 
     improve the care of chronic illness is a complex and major 
     undertaking. Therefore, I want to repeat my comments that I 
     am introducing this bill today to solicit comments and ideas 
     from across the Nation. Today's bill is just the first round 
     in a major initiative to improve this part of our health care 
     system. I look forward to additional ideas and suggestions.
       Following is a section-by-section description of the 
     proposal.

     The Chronic Illness Care Improvement Act of 2000 Bill Summary

       1. The bill charges a congressionally-appointed National 
     Commission with development of a Medicare policy agenda that 
     provides for an integrated, comprehensive continuum of care 
     for serious and disabling chronic illness. Among its 
     responsibilities, the National Commission on Improving 
     Chronic Illness Care will:
       Raise public awareness about how and why chronic illness 
     care should be improved;
       Investigate the barriers preventing integration of care for 
     the chronically ill and establish baseline data for 
     benchmarking future progress in reducing the prevalence of 
     chronic conditions and healthcare costs;
       Establish direction for integrating the delivery, 
     administration and finances of chronic care services.
       III. The bill lays the groundwork for a national program of 
     coordination and integration of care for serious and 
     disabling chronic illness through initiatives addressing:
       Prevention of Disease and Progression of Disability: 
     Preventive services under Medicare are expanded. Research is 
     also expanded into risk factors associated with the 
     progression of disability. A public awareness campaign on 
     prevention of chronic illness is established and bonus 
     payments are offered to reward plans and providers that meet 
     targets for reducing disability.
       National Targets for Improving Chronic Care: HHS will 
     develop a national database for long-term planning and 
     measurement of outcomes; will set national goals to reduce 
     the prevalence of chronic illness; and will develop outcomes 
     measures for analysis of

[[Page E1336]]

     long-term effectiveness of interventions that prevent chronic 
     illness, complications and disability.
       Coordination and integration of health services across 
     different care settings: Common patient assessment 
     instruments-are developed to integrate care across settings. 
     Medicare and Medicaid-services for dually eligible 
     beneficiaries are coordinated by streamlining the processes 
     of obtaining waivers and determining budget neutrality for 
     these programs.
       Adequate manpower, education and expertise in chronic 
     illness: Expand training opportunities where shortages of 
     physician's with chronic illness expertise exist and HHS-
     sponsored, Internet-based national resource centers are set 
     up to serve chronic illness patients and providers.
       Managed care bonus programs for excellence in integration 
     of chronic illness care:, Bonus payments are provided through 
     Medicare for the development of comprehensive programs 
     serving chronically ill beneficiaries. Specifically, 
     disability prevention programs that achieve prevention goals, 
     improve quality or perform research into delaying the 
     progression of disability or preventing disease-related 
     complications are funded.
       Development of methods of cost assessment that make sense 
     for long goals and outcomes: Methodologies to measure long 
     range costs of comprehensive disease management programs that 
     prevent chronic illness, delay disability, and prolong 
     independence are developed and implemented by HHS.
       III. The bill implements a nationally Phased-in program of 
     comprehensive integration 'and coordination of care for 
     serious and disabling chronic illness by:
       Establishing-Prototype models for comprehensive disease 
     management of two chronic illnesses, diabetes and Alzheimer's 
     disease in 2003, that will be used as the basis for expanding 
     in 2007 to other serious and disabling chronic illnesses, 
     including hypertension, heart disease, asthma, arthritis, 
     multiple sclerosis and Parkinson's disease.
       These comprehensive disease management programs known as 
     The National Initiative to Improve Chronic Illness Care 
     include these key components: Best practices and evidence-
     based clinical guidelines, Interdisciplinary care, Case 
     management, Disability prevention, Patient and caregiver 
     education to foster self-management, Medication monitoring, 
     Integrated administrative and financial services, Integrated 
     information systems.

     

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