[Congressional Record (Bound Edition), Volume 151 (2005), Part 7]
[Senate]
[Pages 8815-8816]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           CARE COORDINATION

  Mr. KENNEDY. Mr. President, I welcome this opportunity to call the 
attention of my colleagues to the important issue of improving the 
coordination of health care for the Nation's senior citizens. As we all 
know, large numbers of senior citizens receive health care and 
treatment from several different physicians. In fact, more than half 
the patients with serious chronic conditions have three or more 
different physicians.
  Too often, a physician seen by a patient is not aware of the tests 
and prescriptions that other physicians have ordered for the same 
patient. The result is that the patient receives care that is often 
duplicative, and may actually be harmful.
  We need new ideas on improving care coordination for patients--
particularly for senior citizens.
  The Boston Globe recently published a thoughtful article by Lois 
Quam, CEO of the Ovations division of UnitedHealth Group, describing 
new initiatives to improve the quality of health services provided to 
senior citizens. It includes a number of worthwhile recommendations, 
and I urge my colleagues to take the time to read it carefully. We can 
clearly do better, much better, in this important area of health care.
  I ask unanimous consent that the article ``Rx For Medicare'' be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                 [From the Boston Globe, Mar. 11, 2005]

                            Rx for Medicare

                             (By Lois Quam)

       Social Security reform will dominate politics and be the 
     subject of much debate for months to come. However, failure 
     to address rising healthcare costs, by changing the way 
     Medicaid and Medicare-funded care is delivered, could 
     undermine efforts to ensure financial security for many 
     retirees.
       Over the next 75 years, the government is expected to pay 
     more than $27 trillion in healthcare benefits promised to 
     seniors seven times its Social Security obligations for that 
     period. Further, a recent analysis by Urban Institute 
     researchers suggests that by 2040, typical seniors might have 
     to spend approximately one-fifth of their Social Security 
     benefits on Medicare premiums.
       Simply cutting funds for federal healthcare programs would 
     be shortsighted and potentially devastating to millions of 
     older Americans, including more than 960,000 in 
     Massachusetts. A better way to control costs while improving 
     the quality of healthcare is to rethink the traditional 
     models for delivering care.
       Chronically ill patients with five or more medical 
     conditions made up only 20 percent of all Medicare 
     beneficiaries in 2004 but accounted for more than two-thirds 
     of the program's $302 billion in costs. In any single year, 
     such patients are likely to fill up to 20

[[Page 8816]]

     separate prescriptions, visit emergency rooms a dozen times 
     or more, and require hospitalization at least five times. Too 
     often these patients must make sense of an array of 
     confusing, even conflicting, information. This fragmentation 
     of care can lead to poor health outcomes that are 
     unnecessarily costly and draining for patients and physicians 
     alike. We can reduce this burden by organizing our resources 
     more efficiently and effectively.
       The traditional Medicare and Medicaid fee-for-service 
     systems are structured primarily to provide acute care, not 
     to meet the needs of the chronically ill. These latter 
     patients require comprehensive management of their health, 
     emphasizing coordination of multiple treatments, health 
     maintenance, and prevention of disease. While there has not 
     been any effort to implement a care model of this kind on a 
     national scale, many smaller programs have already 
     demonstrated this approach's value in reducing costs and 
     improving care.
       For example, On Lok SeniorHealth, a community-based 
     organization in San Francisco, provides seniors with a 
     complete program of health services preventive, acute, and 
     rehabilitative care along with home healthcare, social 
     services, and such personal assistance as meal delivery, 
     transportation, and help with prescriptions. On Lok's 
     patients report better overall health and fewer acute-care 
     needs and hospitalizations than comparable groups of Medicare 
     beneficiaries.
       I have also seen the impact of this care model at my own 
     company. Our Evercare plans identify the most costly, at-risk 
     patients and deliver care within a system of careful 
     monitoring and management. At the heart of this system are 
     practitioners who coordinate multiple services, facilitate 
     communication between providers and patients, and ensure 
     integration of treatments.
       Evercare is also working with Massachusetts to ensure this 
     kind of care is brought to seniors living in nursing homes, 
     as well as to home-based elderly and disabled. The 
     Massachusetts Senior Care Options program provides enrollees 
     with hands-on medical care coordination as well as home care 
     support services, such as outfitting the home for special 
     needs, housekeeping, transportation to physicians' offices, 
     and meals.
       Again, there is evidence that the model can reduce costly, 
     redundant services while improving patient care. Federally 
     commissioned studies of Evercare programs in several states 
     showed that they slashed hospitalizations in half while 
     gaining a 97 percent satisfaction rating from participating 
     families. The Centers for Medicare and Medicaid Services 
     point to Evercare as the model for the Special Needs Plans 
     included in the Medicare Modernization Act of 2003. In Texas, 
     another program using this model saved more than $100 million 
     in two years and improved seniors' access to services.
       The long-term survival of Medicaid and Medicare may depend 
     on the wide adoption of this approach, whether it is offered 
     by private companies such as Ovations or not-for-profit 
     programs like On Lok. We have an opportunity to do so for the 
     chronically ill within the framework of the Medicare 
     Modernization Act's Special Needs plans. However, both the 
     public and private sectors need to do a much better job of 
     analyzing the effectiveness of alternative-care models and 
     applying evidence-based lessons on a nationwide basis.
       By working together, public and private leaders have the 
     opportunity to improve the quality of life for more than 41 
     million older Americans and conserve Medicare resources. This 
     issue also affects younger generations, who must have the 
     security of knowing that their parents, and then they 
     themselves, will be well cared for as they age. But we need 
     to move quickly, beginning this year. If we wait until 
     Washington deals with Social Security and other issues on its 
     agenda, we may simply run out of time.

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