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Cuts threaten integrated health care

As our nation’s health care system grows ever more complex, there is a simple and unified approach to truly improving patient outcomes and quality of care: integrated care.

Integrated care – or, care that is purposefully coordinated – is a system that emphasizes and facilitates communication between doctors and the various sites of services. Therefore, specialists treating the same patient can align their care plan to successfully combat numerous chronic diseases.

The result is highly efficient, personalized care – all without the redundancy and wasted hours patients often experience trying to navigate our current fragmented health care system.

As chief medical officer for the ABQ Health Partners, I have had the opportunity to witness the benefits of care coordination firsthand. While working in interdisciplinary clinical teams, we concentrate our efforts on quality of care, rather than quantity. Not only are we finding that this approach leads to healthier patients, but also results in high patient satisfaction and generates significant savings across the health care system associated with the prevention of avoidable readmissions.

Current physicians – as well as our nation’s next wave of caregivers – consider integrated care as central to good health.

As doctors, we want what is best for our patients. Therefore, it is evident that we must ultimately scale up the coordinated care model in order to ensure its clear health benefits, and outcomes, to millions of needy American patients.

Currently, Medicare Advantage is the only coordinated care option for Medicare beneficiaries. The program is exceedingly popular. In fact, there are more than 102,000 New Mexicans already enrolled in Medicare Advantage plans, and another 15 million patients nationwide.

Ninety percent of Medicare Advantage beneficiaries are satisfied with their plan, according to a recent study. And even more – an impressive 94 percent – are happy with the quality of care they receive under their plan.

Patients with Medicare Advantage plans are clearly benefiting from care coordination. Among a national MA patient population we’ve treated within our network using an integrated care model, we have witnessed a 37 percent drop in hospital admissions and a 21 percent reduction in rehospitalizations – generating potential savings for both patients and Medicare.

Despite much evidence demonstrating the value of integrated care, there are currently a number of roadblocks preventing our nation’s most vulnerable patients – our seniors – access to effective care coordination. Most damaging among these are recent legislative cuts to Medicare Advantage.

In recent years, federal policymakers approved $200 billion in targeted cuts to the program. These cuts are mystifying in light of recent anecdotal and concrete data mentioned above, and if fully implemented over the coming years, will become detrimental to patients who could reap the health benefits of Medicare Advantage.

Under current law, approximately $24.5 billion in cuts will be implemented in 2015 alone, creating an uncertain environment for the program as well as its consumers.

As a country in need of sustainable reforms in the health care sector, this legislation moves us in the wrong direction. Not only does it stifle the potential of integrated care, it puts millions of patients at risk.

Fortunately, New Mexico’s Rep. Michelle Lujan Grisham has battled to protect Medicare Advantage, and we commend her for her leadership fighting for New Mexico seniors. But Lujan Grisham cannot do it alone. Her efforts must be reinforced by additional bipartisan allies looking to make a measurable difference in the lives of their constituents by protecting this critical and popular program from unnecessary cuts.

The future of Medicare Advantage and integrated care is now in the hands of Congress. Yet even as they push for comprehensive reform, policymakers need only consider one simple question: How can we make sick patients healthy again?

Once again, the answer is simple: allow the skills and talents of doctors to fully flourish through a system that finally puts the patient back at the forefront of care delivery.


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