The Campaign for Better Care appreciates the opportunity to submit a statement for the record on the Impact of the Affordable Care Act on Medicare beneficiaries. 

The Campaign for Better Care (www.campaignforbettercare.org) is a broad-based coalition of consumer organizations with a direct stake in improving the health and quality of life for older adults with multiple health conditions and their family caregivers.  We are committed to ensuring that new models of care delivery and payment, including Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMH), provide the comprehensive, coordinated, patient- and family-centered care that individuals want and need.

Changing the way health services are delivered and paid for is key to fulfilling the promise of high quality, patient- and family-centered care for millions of Americans.  Our fragmented delivery system has failed those who rely on it the most.  Hardest hit are vulnerable populations, including older adults with multiple chronic conditions, and their family caregivers, who struggle to navigate an impossibly complex health care system without the help they need. This population uses the most health care services, at the highest cost.  Because no one is helping them coordinate their care, they suffer the poorest health outcomes.

The ACA can help address these problems.  In addition to improving health care coverage and affordability, the law makes significant advances in improving the way health care services are delivered and paid for, moving us toward a health system that rewards value over volume, promotes better coordinated care, and is oriented around the needs of patients and families.

Changing How Care is Delivered

Nine out of ten older Americans (age 65 and older) have at least one chronic health condition and 77 percent have multiple chronic conditions.^[i]  These are the people who could most benefit from better coordination of care.  Yet, to date, our health care system – including Medicare – has not risen to the challenge. 

The ACA promotes innovative new ways to deliver health care that will promote higher quality, better coordinated, more efficient care. These new approaches should foster better communication and coordination among health care providers, patients and family caregivers, and help prevent problems like harmful drug interactions, unnecessary hospitalizations, conflicting diagnoses, and failure to connect people with community based services that can help them manage their health. 

Improving Medicare

Medicare is a lifeline that offers older Americans secure health coverage. But there are notable gaps in Medicare’s coverage that cost beneficiaries millions of dollars out of pocket and often prevent older persons – particularly those with numerous chronic conditions – from getting the care they need. 

The ACA fills in some of these gaps – making Medicare more affordable for millions of older Americans.  Because of the ACA, Medicare beneficiaries can now get an annual physical and access to a number of preventive services, such as mammograms and colorectal screenings, without expensive out of pocket costs.  And the ACA’s changes to the donut hole will save these beneficiaries thousands of dollars.  Last year, beneficiaries who fell in the “donut hole” received a $250 rebate. This year, they will benefit from 50 percent off brand name drugs in the donut hole. By 2020, the donut hole will be closed.

The newly established Federal Coordinated Health Care Office will work to improve coordination between Medicare and Medicaid for dually eligible beneficiaries and help to ensure that care for this population is more efficient.

Changing How We Pay for Care

The current health care system pays for care based on volume not value.  The ACA begins to link payment to provider performance and quality of care, providing much-needed incentives for quality improvement.  Increasing Medicare and Medicaid payment for primary care providers will help to ensure that patients have ready access to good primary care, which is particularly important for older adults struggling with multiple chronic conditions, who need a higher level of care coordination and care management.

Improving the Quality of Care

The new law includes policies that will help us move away from a system that values quantity over quality – and toward a system that prioritizes effective delivery of the right care, at the right time, for the right patients.  New policies will link payment to quality and provider performance, creating much needed incentives for quality improvement by hospitals, physicians, nursing homes, home health providers and others.

Changing the Health Care Workforce

The ACA also makes strengthening and expanding the health care workforce a priority.  It supports programs aimed at increasing the supply of qualified primary care providers, and training our health care workforce so it better meets the complex health needs of older patients.

Conclusion

The ACA offers us an opportunity to make our health care system more efficient and more patient- and family-centered, which is critically important for older patients with multiple health problems and their family caregivers.  As a nation, we simply cannot afford to delay implementing the new law.  The health and well-being of millions of Americans – including older and chronically ill persons – depends on it.