HEALTH

CMS chief Berwick is driving hard to spur health innovation, report says

BY Jim Frederick

WASHINGTON The recently installed head of the federal Medicare program is pushing hard to promote new and more cost-effective ways to treat patients and improve the nation’s health scorecard.

On Monday, The Boston Globe reported that Donald Berwick, tapped by President Obama in July as administrator of the Centers for Medicare and Medicaid Services, is working to expand health-innovation projects around the country in line with the massive health-reform law enacted earlier this year. Berwick envisions as many as 300 test sites devoted to developing new, integrated models of patient care by physician groups and other health professionals, according to The Globe.

 

Spurring those innovative pilot projects will be billions of dollars allocated by the health-reform bill for a health innovation center, and for the development of health information technology to eliminate waste and promote better decision-making among doctors, pharmacists and other health providers.

 

 

To that end, Medicare will designate provider groups participating in the innovation pilot projects as “accountable care organizations’’ under the program, the newspaper reported. The underlying goal: to replace the costly and increasingly unwieldy fee-for-service model that now dominates such public health programs as Medicare and Medicaid, with “global payments” that reward healthier patient outcomes and coordinated care among physicians and other providers, according to The Globe.

 

 

Berwick, the report noted, is a strong advocate for experimentation in new, outcomes-based models of patient care, and is working to double the size of the innovation center and promote its involvement in new healthcare demonstration projects. Test sites for new collaborative care models will be up and running by the end of 2011, The Globe reported.

 

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NACDS, NCPA in joint statement praise CMS’ move to withdraw provisions of AMP rule currently blocked by injunction

BY Drug Store News Team

ALEXANDRIA, Va. National Association of Chain Drug Stores president and CEO Steve Anderson and National Community Pharmacists Association acting EVP and CEO Douglas Hoey issued a statement praising the proposed rule by the Centers for Medicare and Medicaid Services that would withdraw existing provisions of the Medicaid pharmacy reimbursement formula under the average manufacturer price model.

"We are pleased that the Centers for Medicare and Medicaid Services has proposed a rule that would withdraw provisions of what is known as the Medicaid average manufacturer price rule. The proposed rule calls for the withdrawal of existing provisions that define AMP, that determine the calculation of federal upper limits, and that define ‘multiple source drug.’ Put simply, all of these provisions relate to the reimbursement to pharmacies for generic Medicaid prescriptions, and thus impact patients’ access to pharmacies. The move to withdraw these provisions is a victory for patient care as it is delivered in America’s pharmacies every day."

"When we filed the lawsuit in 2007 we knew that patient care was at stake. It is important to point out that the withdrawal of these provisions is another step toward reducing what would have been major cuts to pharmacy reimbursement. The end result is not an increase in reimbursement to pharmacy, but rather the lessening of cuts that previously would have involved pharmacies selling most generic drugs at a loss, thereby threatening their long-term ability to provide patient care."

 

“We insisted that this policy was not appropriate. Separately, we also have urged that policy-makers should recognize the ability of pharmacies and pharmacists to help improve health and reduce healthcare costs. We are gratified that this sense is reflected in the pharmacy provisions of the new healthcare-reform law. The new law contains provisions ranging from dramatically reducing the AMP cuts to advancing medication therapy management, through which pharmacists can help patients take their medications correctly. … The costs related to poor medication adherence have been estimated to reach $290 billion annually, or 13% of all healthcare expenditures. We urged that patient care should not be jeopardized, but rather that pharmacy be engaged more strategically for the good of patient health and healthcare delivery."

 

“We anticipate issuing formal comments on CMS’ proposed rule to withdraw these provisions of the AMP rule, and we will continue to work with Congress and with CMS to advocate for access to pharmacy services for patients.”

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In push for MTM, Kerr hosts senator

BY Jim Frederick

RALEIGH, N.C. Extending pharmacy’s grassroots outreach to powerful federal lawmakers, Kerr Drug hosted Sen. Kay Hagan for a pharmacy and health center tour that drew praise from the North Carolina democrat.

Hagan toured the patient care area of a Kerr drug store in the company’s home market, and used the opportunity to talk with patients and pharmacists about the value of pharmacy-based clinical care, and to praise the skills of pharmacists in improving patient care and controlling health costs. During her visit, Hagan also promoted the expansion of medication therapy management services to Medicare Part D recipients.

Hagan is a co-sponsor of S.3543, The Medication Therapy Management Expanded Benefits Act of 2010. The bill — a similar version of which has been introduced in the House of Representatives — would expand MTM coverage to any senior suffering from any chronic condition that accounts for high spending in the healthcare system. Hagan also worked to include an MTM provision in the new healthcare-reform bill, creating a grant program to promote MTM services.

“The most effective and cost-efficient way to ensure seniors take their medication properly is through the counseling of a pharmacist,” said the lawmaker during her tour. “The evidence shows pharmacists can improve patient health and save healthcare dollars because pharmacists are often the most accessible healthcare provider for patients.”

Added Kerr chairman and CEO Tony Civello, “We know that for every $1 invested in MTM, overall healthcare costs are reduced by $8 or more. Sen. Hagan understands that value. Pharmacy is evolving to a more patient-centered focus as patients and providers realize the value of pharmacy in improving health care.”

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