For Patients With Multiple Chronic Conditions, Improving Care Will Be A Bipartisan Effort (Health Affairs Blog)

HEALTH AFFAIRS BLOG | While federal policy makers are undertaking controversial and divisive debates over the future of the Affordable Care Act, Republicans and Democrats have had a good track record of working together to improve health care delivery and payment frameworks. Most recently, the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 reformed Medicare’s physician payment system to better link payment to quality, as well as incentivize participation in models of care outside of the traditional fee-for-service system. These alternative payment models continue a history of bipartisan work in delivery system reform by shifting away from fee-for-service (FFS) and toward a more coordinated, efficient system of care. The shared goal of ensuring high-quality, high-performance, and affordable health care presents a unique opportunity for further bipartisan agreement. Building upon this goal, we should also work to advance a more patient- and family-centered approach to delivering care, especially to those with complex, high-cost health care needs.

A good place to start, and an area where policy makers have already placed an increased focus, is on developing solutions within federal health programs to improve outcomes for individuals with multiple chronic conditions and functional limitations. People with multiple chronic conditions typically use more services, such as emergency department visits, hospitalizations, and eventual need for long-term services and support, compared to those without multiple chronic conditions. For those with complex health needs and functional impairment, health care expenditures averaged $21,000 annually, more than four times the average for all US adults. This spending trajectory is unsustainable for both patients’ pocketbooks and the health care system as a whole, and the care they receive is often fragmented and confusing.

Read more at Health Affairs Blog: https://www.healthaffairs.org/do/10.1377/hblog20170601.060354/full/

What a Difference a Decade Makes

(The Hill, May 28, 2013)

By Rep. Barbara Lee and Bill Frist

A Democratic Congresswoman and a former Republican Senator aren’t afforded many opportunities to work together. Especially at a time of fiscal crisis when every dollar is scrutinized and fought over, partisanship pushes us into opposite corners. But we agree on a program that truly has bipartisan support, saves millions of lives a year, and contributes directly to stability, security and economic growth worldwide.

Ten years ago this May, when the AIDS pandemic was at its worst, ravaging many African countries and a sure death sentence for millions, our country responded in an unprecedented way. We both, along with the late Republican Congressman Henry Hyde and the late Democratic Congressman Tom Lantos, worked with the Congressional Black Caucus and a bipartisan group of legislators to address this enormous problem. Soon after, in 2003, then-President George W. Bush instated PEPFAR, the President’s Emergency Plan for AIDS Relief, pledging $15 billion over five years to combat the spread of HIV, prevent further infections and improve access to care for millions of people across the globe.  Each year since then, Congress, with bipartisan support, has stood behind the program, providing critical funding to enable PEPFAR to truly help change the trajectory of the AIDS epidemic.

Now, a decade later, PEPFAR’s success isn’t just measured in dollars spent, but in lives saved and communities improved. The Institute of Medicine called the program “transformational” in global health.

PEPFAR has directly supported life-saving antiretroviral treatment for nearly 5.1 million men, women and children around the world, and is helping prevent hundreds of thousands of mother-to-child transmissions, an essential step toward achieving an AIDS-free generation. Engaging women is crucial to the broader goal; about half of the people living with HIV worldwide are women, and their empowerment is critical to beating this disease. PEPFAR supported HIV testing and counseling for more than 11 million pregnant women in 2012 alone.

Because of PEPFAR, we’re not just working toward an AIDS-free generation, we’re achieving an AIDS-free generation.

All around the world, PEPFAR is caring both for the health of the individual and the health of communities. The medications and programs supported by PEPFAR are so effective that people living with HIV/AIDS are doing just that — living. Infected individuals can care for their families and hold jobs. Communities enjoy economic stability. The United States earns a positive reputation.

But we are at a tipping point to truly realize this vision. If we back away now, the gains we’ve made will evaporate; the success we’ve had will disappear. Support of PEPFAR now is as important as it was 10 years ago.

HIV is a virus, not an ideology. Democrats and Republicans should be proud of PEPFAR’s legacy and continue to support it moving forward, providing the program with the robust funding it still needs to help achieve an AIDS-free generation.

Lee serves on the House Committee on the Budget and the House Appropriations subcommittee on State, Foreign Operations, and Related Programs, and is founding co-chair of the Congressional HIV/AIDS Caucus and represents the United States on the United Nations’ Global Commission on HIV and the Law. Frist is adjunct professor of surgery at Vanderbilt and Meharry medical schools and former majority leader of the U.S. Senate.

This article was originally featured in The Hill http://thehill.com/opinion/op-ed/302249-what-a-difference-a-decade-makes-

Need for Affordable Care Cuts Across Party Lines

(The Hill, August 1, 2012)

Need for affordable care cuts across party lines
By Tom Daschle and Bill Frist

On June 28, 2012, the Supreme Court issued a decision that affects the health and well-being of every American, as well as the fiscal future of our nation. By affirming the constitutionality of the Patient Protection and Affordable Care Act (PPACA), the private and public sectors can now turn to implementation, along with natural and needed shaping and modification of the underlying policy along the way.

The court’s decision can and should be a turning point for our national discussion and action on healthcare. Though the upcoming elections might amplify our differences in the short term, it is in the long-term interest of every American to begin now to work together and forge consensus-based solutions for our nation’s most critical healthcare challenges.

The United States currently has an expensive, uncoordinated and inefficient healthcare system. By 2020, healthcare spending will make up one-fifth of our national economy. Excessive and wasteful healthcare spending fuels our nation’s exploding federal debt and imposes unsustainable burdens on our federal and state governments, employers, individuals and their families. This is a grave threat to our nation’s future health, economic viability and ability to compete in an increasingly competitive global marketplace.
As the co-leaders of the Bipartisan Policy Center Health Project, our mission is to bring together federal, state, business and workforce leaders to develop health system solutions that address ongoing budgetary and healthcare reform challenges. We are embarking on a new initiative to confront and curb the country’s out-of-control healthcare cost growth: Our goal is to promote a rational, competitive, accessible and affordable healthcare system. We will be collaborating on this initiative with Alice Rivlin and former Sen. Pete Domenici (R-N.M.), the distinguished co-chairs of the Bipartisan Policy Center Debt Reduction Task Force. The task force is dedicated to reducing the federal deficit and helping America achieve a sustainable fiscal path, which simply cannot be accomplished without significant healthcare reform.

Healthcare cost containment is a profoundly complex and divisive issue, but we are steadfast in our belief that this issue can be addressed in a meaningful way. We as a nation cannot wait any longer. Our broken healthcare system can be fixed; there are solutions to each of the challenges. But we will never devise and apply them until we commit to do so together, reaching across the political aisle to work with one another.

All Americans generally agree on the end goals for health reform — appropriate and effective patient care, lower costs and easier access for all. We might not agree on the individual mandate, but we do agree on the power of embracing personal responsibility for our health and health decisions. We do not always agree on the most effective way to execute state insurance exchanges, but we can agree that these exchanges provide opportunities for states to use the power of market competition to control costs and engage their constituents on the individual level.

We all know that greater transparency in pricing and outcomes will help eliminate duplication, waste and inefficiency. We want to see our system provide frictionless and coordinated care that brings satisfaction to caregivers and peace of mind to patients. We want our health records and data systems to be brought into the 21st century through health information technology, providing vital health information when and where it is needed instantly and securely. The only question is how we get there.

Healthcare is in a period of explosive growth and transformation. Every day, the sector performs technological miracles, creates jobs and saves lives. We must harness this power, but at the same time, strive to do more. The American healthcare system has the power to be more efficient and more accurate, without sacrificing our nation’s capacity for private-sector innovation, productive public-private collaboration and incredible technological advancement.

Allowing healthcare costs to soar at unsustainable levels and allowing America to fall behind on key indicators of care quality and access is not a political victory for either side of the aisle. Assigning blame along partisan lines gets us nowhere.

A healthy population, a happy and productive workforce, and affordable healthcare are vital to the future of our nation. Unless we are willing to work together to transform our healthcare system for the better, these essential goals will remain out of our reach.

Former Senate Majority Leaders Daschle (D-S.D.), now a senior policy adviser at DLA Piper, and Frist (R-Tenn.) lead the Bipartisan Policy Center’s Health Project.

This article was originally featured in The Hill http://thehill.com/blogs/congress-blog/healthcare/241701-need-for-affordable-care-cuts-across-party-lines

Is AIDS the last bipartisan issue?

(The Week, July 31)

These days, Washington can’t agree on anything. Thankfully, though, some brave lawmakers are still willing to cross the aisle to fight a deadly disease.

We live in fiercely contentious times. Every day, it seems, a new issue arises that Democrats and Republicans cannot agree on. Health care, taxes, energy, favorite flavor of ice cream — it seems our elected leaders must disagree at every turn. But one issue that has so far repulsed the partisan pressures of the times was highlighted in our nation’s capital last week: the fight against HIV/AIDS.

Washington, D.C., hosted the XIX International AIDS Conference. It was an energetic, passion-filled week. More than 23,000 attendees from across the globe heard and engaged speakers including both former President Bill Clinton and Secretary of State Hillary Clinton, cutting edge research scientists, activists, Nobel laureates, world leaders, and even a few celebrities. Perhaps even more important, many HIV positive men and women came together from dozens of countries to find a caring, supportive community.

The United States — and more specifically, the American taxpayer — has been the undisputed world leader in fighting this cagey virus for which there is no cure. This single virus has taken the lives of more than 580,000 Americans and 25 million globally since it emerged here in our country just over 30 years ago. The conference was a celebration of the remarkable success made because of this leadership, and a call for continued support.

When we stop the hollowing out of societies and inspire hope, there is no limit to what we can accomplish together.

As moderator for a panel on the congressional role, I witnessed what I felt to be an accurate portrayal of how we got to the point where we could celebrate so many successes. Fundamental to the progress has been bipartisanship. Participating were two Democrats, Reps. Barbara Lee (Calif.) and Sen. Chris Coons (Del.), and two Republicans, Sens. Marco Rubio (Fla.) and Mike Enzi (Wyo.).

Our panel’s balanced party identification was more than symbolism, as Rep. Lee acknowledged when she described the U.S. response as bipartisan, saying, “it never would have happened without … Republicans in the House and the Senate.” Indeed, the bold $15 billion PEPFAR commitment initiated by President George W. Bush and supported by Congress was quickly taken up and expanded under the Obama administration. All panel members were quick to praise the leadership and dedication of the other’s party.

And there is cause for such praise. PEPFAR, unprecedented in scope and size in its combatting of a single disease, has saved millions of lives, provided 4.5 million people with treatment, enabled hundreds of thousands of HIV positive mothers to give birth to healthy, disease-free children, and allowed tens of millions to receive testing, counseling and care. In 1995, 50,000 Americans died of AIDS. In 2009, that number was down to 20,000. Promisingly, partner countries are increasingly supporting this work internally. Last year, poorer countries invested $8.6 billion into the fight as international financing provided by wealthier nations amounted to $8.2 billion. As I have said for years, when we stop the hollowing out of societies and inspire hope, there is no limit to what we can accomplish together.

The results of this bipartisan American commitment are in, and they are undeniable. Our past investment has inspired others to contribute, saved lives at home and around the world, and empowered economic development with a healthier workforce. But the risk today in a more highly charged partisan environment and in more fiscally challenging times is to say we have done our job and it’s time to move on. That would be a huge mistake, and all our progress would be erased because we still don’t have a cure. Around the world and at home, the AIDS epidemic is far from over.

Rep. Lee noted that there are still American communities where “the percentages [of AIDS] are comparable to sub-Saharan Africa.” This is unacceptable, and you do not have to look far into the past to a time when both parties wholeheartedly understood this.

As Sen. Enzi recollected, in 2003 the PEPFAR bill “passed both the House and Senate unanimously, un-amended, in less than two months. That never happens.” But Enzi elaborated that five years later, when the time came for reauthorization under President Bush, the measure passed “again in a bipartisan way” — although “we didn’t have quite the same votes that we had the first time.”

However, hope for preserving this flame of bipartisan conviction was articulately reflected by the two other members of the panel, Sens. Rubio and Coons, each representing different parties, and neither of whom were in office during the original PEPFAR passage. They have emerged as powerful and knowledgeable voices on global health and HIV. Such leadership is vital when the focus of Congress, today filled with new members who were not around when PEPFAR originally passed, is understandably on domestic issues, the economy, jobs, and health care.

While living and working in Africa in the mid 1980s, Sen. Coons was inspired by the profound human tragedy he witnessed firsthand and has transformed these experiences into true leadership. But he warns that we “can’t take [continued U.S. leadership] for granted in what is an incredibly difficult, very partisan and very divided Congress at a time when our politics are in some ways the rockiest they’ve been in more than a generation.” But out of a world of mudslinging and disagreement, the Democratic senator says it “has been really refreshing to be able to work closely with Republicans” to fight this epidemic.

At a time when our national debt is skyrocketing, the typical American finds it difficult to understand how massive spending for people overseas, even if it is lifesaving, can be justified. But just how massive is this spending really? Not the 25 percent of our budget that most Americans think. In truth, our foreign aid spending is less than 1 percent of the federal budget. As Sen. Rubio, himself a favorite of the Tea Party, eloquently asserted, “If you zeroed out foreign aid it would do nothing for the debt, but it would be devastating not just for the world, but for America’s role in it.”

Progress has been mind-blowing. Science made possible by taxpayer investment through the NIH has brought miraculous new drugs to treat and, just this month, new medicines to prevent. Cost of treatment has fallen ten-fold and continues to plummet. Prevention strategies have turned the tide of devastation. But all this was accomplished because Americans came together, Republican and Democrat, working hand in hand in a bipartisan and meaningful way, rallying together to fashion solutions that are changing the course of history.

As Sen. Rubio declared, “the closer we get to the finish line is not the time to ease up, it’s the time to run through the tape.” Let’s continue to put our partisan differences aside and run this one together.

Dr. William H. Frist is a nationally acclaimed heart transplant surgeon, former U.S. Senate Majority Leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery, and author of six books. Learn more about his work at BillFrist.com.

This article was originally featured in The Week http://theweek.com/article/index/231271/is-aids-the-last-bipartisan-issue