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National Association of States United for Aging and Disabilities

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September 12, 2011
Washington, DC

Remarks as prepared for delivery

Thank you very much for that kind introduction. I am delighted to be here.

I want to thank Martha Roherty, Carol Sala and everyone here with the National Association of States United for Aging and Disabilities for hosting this event and making this conversation possible.

I also want to acknowledge our terrific Assistant Secretary for Aging Kathy Greenlee. I know you heard from Kathy this morning, and she is an incredible champion for America’s seniors.

And she is part of an incredible team at our department, which includes CMS, our Office for Disabilities, our Office for Civil Rights, SAMHSA, which focuses on mental health issues, and the Administration for Developmental Disabilities.

This is a pivotal moment for long-term care in America.

Today, approximately 10 million Americans need long-term services and supports. That number is rising steadily. By 2020, it’s expected that 15 million Americans will need some kind of long-term care.

But for too long, far too many of these people have faced an impossible choice between living in a nursing home away from their loved ones or living at home without the long-term services and supports they need.

Our philosophy is simple: we want to give them better choices.

That’s why over the last two and a half years, the Obama Administration has launched an ambitious agenda to make it easier for Americans to get long-term care at home and in the community.

That agenda starts with the Affordable Care Act, the most far-reaching commitment to home and community based services since the Americans with Disabilities Act became law 21 years ago.

And I want to underline a few key examples of how we are working with states as they continue moving toward a community-first approach to long-term care.

First, the law extends the life of our Money Follows the Person program for another five years.

This is a proven program that has already helped more than 12,500 people on Medicaid transition out of an institutional setting into their own communities. And this additional investment will help tens of thousands more people move from an institution to a home of their own by 2016.

Second, the law contains the Community First Choice option which, starting October 1st, will provide extra money to state Medicaid programs to improve the quality of the services and supports people do receive at home.

Third, we’re giving states tools to monitor and track their direct care workforce – the largest and fastest growing workforce in the nation.

Now, states will have access to the comprehensive data and resources they need to make sure the people who need care can get it, and that the people providing care have access to the best practices and expertise of their peers.

Finally, I’m pleased to announce our latest initiative: additional support to states that have continued struggling to meet their Olmstead obligations.

Through the Balancing Incentives Program, states will make changes to move away from relying on nursing homes such as establishing a “no wrong door” system, and in return, they’ll get increased Medicaid payments. Starting next month, up to $3 billion will be available for the program.

At the heart of each of these initiatives is a deep commitment to helping people live as independently as possible. It’s a belief that the right support and care should be there for everyone who needs it – and that, by giving everyone the freedom to contribute and participate, we all benefit.

This is the same belief that led us as a nation to provide basic security, including health care, for seniors and our most vulnerable citizens through Medicare, Medicaid, and Social Security – and more recently through the Americans with Disabilities Act and the Mental Health Parity and Addictions Equity Act.

It’s easy to forget that before Medicare and Medicaid were enacted in 1965, half of our seniors had no insurance and private insurance companies had little interest in selling them coverage. People living with chronic or disabling conditions too often had no source of financing for critical services and supports. And countless seniors and people with disabilities in this country were at risk of bankruptcy as a result of health care costs.

Today, 46 years later, virtually every American over the age of 65 is covered by Medicare. And millions of Americans with chronic and disabling conditions have access to long-term services and supports through Medicaid.

Over a million Americans who are elderly or have disabilities receive Medicaid-funded home and community based services, getting the care they need to remain at home and live productive lives in the community.

We can’t take that for granted.

So today we are taking action to ensure that every American receives better care – wherever they may be, at the doctor’s office or in the hospital -- in their community or at home.

Under the Affordable Care Act, we are moving toward a system where all patients have more quality time with their doctors; where doctors talk to each other to improve care; and where the focus is on preventing illness before it happens.

Today, insurance companies pay doctors based on the number of patients they can squeeze into a day or how many procedures they do.

But we know that when doctors have time and the right technology, they can share what they know and make sure patients get the right tests and the right medications.

We want a system where it’s easier for everyone to spend more quality time with their health care providers.

When patients and their doctors have time to work closely together to make person-centered care plans, people stay healthier and dollars are spent more wisely.

We know this is possible because it already exists.

For example, Wishard Health Services in Indianapolis is the third largest safety-net health organization in the country providing care to approximately 7,000 low-income seniors. About a third of them are eligible for both Medicare and Medicaid.

Wishard has implemented an integrated care model specifically targeting these high-risk seniors with multiple chronic conditions.

Working together, a social worker nurse and a nurse practitioner provide an in-home assessment and create an individualized plan of care. That plan is then consistently tracked though a web-based system that is connected to both the patient’s health care providers and their sites of care.

By its second year, Wishard saw a 44 percent reduction in hospital admissions -- the kind of dramatic progress that means better health and also lower costs. By the second year, they were saving an average of $1,500 for each high-risk patient enrolled in the program.

I have been travelling around the country where I have met innovators like these in communities around country.

Our goal is to help identify the best strategies out there and help them spread. And so HHS has joined with more than 2,500 other hospitals nationwide, along with hundreds of employers, health insurers, provider organizations, and patient advocates, to launch the Partnership for Patients, an unprecedented alliance that will promote innovations to improve care and reduce wasteful spending.

We've never seen this many high-level partners join together to improve care. And to get started, we set two ambitious goals for the next three years.

We want to reduce preventable injuries in hospitals by 40 percent. And cut readmissions by 20 percent, targeting the return trips to the hospital that should never have occurred.

That’s where you come in.

We know that one in four heart attack patients and one in five heart failure patients are back in the hospital within 30 days of leaving the hospital. Often, this is because patients don’t get the right follow-up care: they didn’t understand their doctor’s directions, they didn’t eat the right diet or take the right medicines.

There are many reasons why things can go wrong. But we know that one clear way to make sure things go right is to make sure all the doctors and caregivers are talking to one another.

Yet for too long we dismissed the challenges of our fragmented health care system, as if errors and unnecessary readmissions were just a minor bureaucratic quirk. In reality there is a lot more than just some extra paper work at stake. It is people’s lives and livelihoods.

So we’re helping providers coordinate care, especially when a patient is making a transition from one setting to another – at a time when they’re vulnerable and critical information can fall through the cracks.

Under the Partnership for Patients -- we’re asking community-based organizations -- and acute care hospitals that partner with them -- to reduce readmissions by improving care transitions for high-risk patients.

I cannot overstate the role that home and community based services can play in reducing hospital readmission rates.

They occupy a unique space in any patient’s experience. They have the opportunity to coordinate long-term services and supports with primary and acute care services.

And they provide an essential complement to the roles of the hospital, primary care physician, physical therapist and home health providers.

Applications are being accepted on a rolling basis for the Community Based Care Transition Program and as much as $500 million is potentially on the table.

We’re reaching out to engage State Medicaid Agencies and State Agencies on Aging in the Partnership for Patients efforts as well – inviting them to share their own best practices and encouraging their eligible Home and Community Based Service provides to apply and participate.

These efforts also allow us to find new ways to help those patients facing the highest risk. Over the years, leaders in industry have learned that doing something right often costs less than doing it wrong. We believe that same principle applies in health care – that by providing better care, especially for those most in need, we can provide care more affordably.

The dual eligible population for example accounts for 40 percent of Medicaid spending, with most of it paying for long-term care that Medicare doesn’t cover. When beneficiaries have to navigate two programs separately it is no surprise that the care they receive is often inefficient and ineffective.

But we know that we can dramatically improve health outcomes and reduce costs for dual eligibles if we do a better job coordinating their care.

To help do that, the Affordable Care Act created a new Coordinated Health Care Office that focuses specifically on helping states improve care for dual eligibles.

In all of our work to ensure better care and better health, we know we have so much to gain by working together.

I know we are headed in the right direction.

I encourage you to keep pushing harder still, to continue looking and working for new opportunities to bring the aging and disabilities communities together around a shared vision of strong and innovative home and community based services, and access to quality health care.

We face new challenges as our older population grows in proportion to the rest of the population -- and so does the number of people aging with a long-term disability into midlife and beyond. But your work is showing the way forward.

The type of care that every individual deserves is unique to him or her.

It requires time, attention, and thoughtful communication and coordination. We are finally moving toward a system that makes room for those things.

And I look forward to taking the next steps together with all of you.

Thank you.