Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-5386

Title:

AN ACT CONCERNING CARE COORDINATION FOR CHRONIC DISEASE.

Vote Date:

3/10/2014

Vote Action:

Joint Favorable

PH Date:

3/5/2014

File No.:

SPONSORS OF BILL:

The Public Health Committee

REASONS FOR BILL:

To require The Department of Public Health Commissioners in consultation with the Comptroller, hospitals and local regional health departments and other health care facilities to develop a plan to reduce the incidence of chronic disease and improve chronic care coordination

RESPONSE FROM ADMINISTRATION/AGENCY:

Commissioner Jewell Mullen, Department of Public Health (DPH): It is established that deaths and disability from chronic disease could be substantially reduced through widespread adoption of proven preventive interventions. DPH in consultation with the Comptroller, representatives of hospitals and other healthcare facilities, and local and regional health departments develop a plan to reduce incidence of chronic disease and improve care coordination. The Commissioner would be required to submit an annual report to the Committee concerning chronic disease and implementation of the plans described.

Although the intent of the bill is in alignment with DPH's chronic disease goals, additional staffing and infrastructure would be required to meet the bill's requirements.

Representative Bob Godfrey: There are over 26 million people with diabetes in the United States. The American Diabetes Association estimates the total cost of diagnosed diabetes was $245 billion in 2012, up nearly 17 percent from $174 billion in 2007.Kentucky and Texas enabled Diabetes Action Plan legislation in 2011, and seven other states passed legislation in 2013. The Diabetes Action Plan is a new way to help legislators and other policymakers take steps toward reducing the prevalence of diabetes in their states by establishing a collaborative process across state agencies.

I would request that the committee consider including the Diabetes Action Plan in HB 5386. Diabetes needs not only to be treated but in some situations prevented.

The council of State Government (CSG) is the only national organization composed of and serving all three branches of state government. CSG is a region-based forum that fosters the exchange of ideas to help state officials shape public policy.

NATURE AND SOURCES OF SUPPORT:

Susan M. Nesci, Vice President, Public Policy and Advocacy, Arthritis Foundation: Submitted testimony from the following; The Cancer Action Network, American Lung Association, Asthma and Allergy Foundation, Epilepsy Foundation, Lupus Foundation, U.S.Pain Foundation supporting HB 5386 as a means to reduce the impact of chronic disease in Connecticut by improving care coordination. Chronic diseases are the most prevalent, costly and preventable of all health problems. Reducing the impact of chronic disease, such as cardiovascular disease, stroke, heart disease, chronic obstructive pulmonary disease, diabetes, arthritis, and mental health disorders may be the most important factor in reducing health care costs.

There are three measures that would strengthen this bill:

● The commissioner's plan to develop a coordinated care plan should not be limited to just hospitals and health care facilities, but should include other organizations that provide primary care in Connecticut. The plan should also coordinate with the strategies and metrics of the State Innovation Model or SIM, which would eventually affect 80% of the state's insured.

● The plan should involve newly formed entities designed specifically to provide a coordinated approach to care in Connecticut-Accountable Care Organizations, Patient-Centered Medical Homes, etc.

● The plan should include Comprehensive Medication Management (CMM) because the majority of people suffering from chronic disease take multiple medications prescribed by different physicians. Studies have shown that coordinating medication regiment improves clinical outcomes and reduces health care costs. One study found that CMM saved $614 per patient.

A proposed amendment was submitted for consideration that would replace the Comptroller with the Commissioner of Mental Health and Addiction Services to consult with the Commissioner of Public Health. Also, the implementation of this bill would be done within available appropriations was included in the amendment.

Tracy Wodatch, V.P., Clinical and Regulatory Services, Connecticut Association For Healthcare At Home: Supports this bill. HB 5386 outlines a plan that would reduce the incidence of chronic disease, including but not limited to, chronic cardiovascular disease, cancer, stroke, chronic lung disease, chronic metabolic disease and psychiatric illness. The passage of this bill would improve the chronic care coordination in the state and reduce the incidence and effects of chronic disease.

Mag Morelli, President, LeadingAge Coonecticut: Provided testimony offering to participate and assist in any statewide effort to improve care coordination for individuals with chronic disease. Our Members currently are involved in several initiatives to improve care coordination and care transitions for their residents and clients with chronic illness. Many initiatives are being done on a regional basis or are specific to one chronic condition and it would be useful to collaborate in a statewide review of the experience and outcomes of all these initiatives.

Connecticut Hospital Association: This bill calls for the development of a plan for the coordination of care of chronic diseases. Hospitals have played a critical role in improving the health and quality of life of people in our communities, and HB 5386 would allow healthcare providers from Connecticut hospitals to share with the Commissioner of Public Health, and any other stakeholders their experience in identifying and addressing the variety of factors contributing to chronic disease. This would allow hospital-based providers the opportunity to share their best practices in treating patients with chronic diseases.

Boehringer Ingelheim (BI): We are a family owned company committed to the discovery; development, manufacture and marketing of innovative health care products to help to patients address unmet therapeutic needs. We recognize that chronic conditions are a significant issue facing states, and we are committed to continue to make advances in chronic disease areas that are important to patients and their families.

Implementing evidenced-based prevention strategies can reduce health care costs. In Connecticut, nearly two million cases of seven common chronic diseases were reported. The cost of treating these conditions resulted in $3.3 billion, plus the impact of lost workdays and lower employee productivity resulted in an annual economic loss of $12.9 billion in the state.

Boehringer Ingelheim would make the following recommendations:

● The commissioner's plan should include other organizations that provide primary care in Connecticut. The plan should also coordinate with the strategies and metrics of the State Innovation Model or SIM, which would eventually affect 80% of the state's insured.

● The plan should involve newly formed entities designed specifically to provide a coordinated approach to care in Connecticut-Accountable Care Organizations, Patient-Centered Medical Homes, etc.

● The plan should include Comprehensive Medication Management (CMM) because the majority of people suffering from chronic disease take multiple medications prescribed by different physicians. Studies have shown that coordinating medication improves clinical outcomes and reduces health care costs. One study found that CMM saved $614 per patient.

American Association for Retired Persons (AARP): AARP supports effort to improve efficient delivery of optimal care for beneficiaries with chronic illness and disabling conditions that encourage:

● Appropriate use of evidenced-based intervention

● Interdisciplinary care teams composed of physicians, nurses, social workers, dieticians, therapists, pharmacists and others

● Appropriate use and timely monitoring of medications

● Greater affordability of medications

● Accelerated adoption of information technology that contributes to improved care

● Rapid dissemination of information and adoption of effective, evidenced-based chronic care interventions

● Support to family caregivers to help them become effective partners with professionals

● Greater emphasis on chronic care in clinical education and continuing education of health care professionals

● Effective use of the health care workforce

HB 5386 provides the necessary tools to bring a variety of key constituents together to analyze and recommend improvements for chronic care management and reduced incidence of chronic disease. AARP suggests the following as a means to strengthen the bill by modifying section 1(a); to require consultation with consumer representatives and patients with chronic conditions.

John Bailey, Director of Government Relations, American Heart Association: Chronic diseases are among the most prevalent, costly, and preventable of all health problems. Leading a healthy lifestyle greatly reduces a person's risk for developing chronic disease and are essential steps in saving lives, reducing disability and lowering costs for medical care.

The American Heart Association supports HB 5386. By supporting coordinated care for chronic disease, the state will put in place the framework to realize benefits from coordinated, collaborative implementation of evidenced-based interventions, and dissemination of best practices across programs that would have a direct impact on reducing the burden of chronic disease for the top five chronic disease leading causes of death.

Stuart Perry, Past National Chair of the Board of the American Diabetes Association (ADA): Legislation creating and updating of state Diabetes Action Plans is supported by various groups, including the Council of State Governments (CSG), Women in Government (WIG), and National Association of Chronic Disease Directors (NACDD).

Diabetes is a serious issue in Connecticut with prevalent trends increasing. More than 294,900 adults in Connecticut live with diabetes in 2010, compared with 173,00 in 2000. Without significant efforts to address these trends, the burden of diabetes will only continue to grow.

Uncontrolled and inappropriately managed diabetes can cost years of productivity and increase chances of premature death. People with diabetes in Connecticut are twice as likely to report depression, increased rates of heart attacks and strokes, blindness, kidney failures, and amputations. The financial burden of diabetes in America reached $299 billion in 2010, and diabetes and its complications consume one in every 10 America's health care dollar. People with diabetes have healthcare costs that are two times higher than people without diabetes.

The legislation calls for a report every two years assessing the impact of diabetes on state programs, the benefits of existing diabetes focused programs and activities, funding needs and the development of a coordinated action plan to reduce the impact of diabetes, pre-diabetes and related complications on the program, taxpayers and state. The biennial Diabetes Action Plan will offer immediate opportunities to intervene and interrupt the trends in diabetes prevalence that effects individuals and the health care budget.

Margherita Guiliano, Executive VP of the Connecticut Pharmacists Association: Patients diagnosed with chronic disease take medications to control and manage their disease. Medications can be a problem when not taken appropriately. Hospitals are now being monitored for their re-admission rates and adverse drug events account for a primary reason that patients are readmitted to a hospital.

As medications become more and more complex, it is critical that pharmacists be involved in managing and coordinating medications with patients across the care continuum. Pharmacists are often underutilized because a reimbursement mechanism has yet to be developed.

The Connecticut Pharmacists Association recommends that this legislation include a pharmacist as one of the consultants to the Commissioner of Public Health to provide input into the plan. This would assure that there is additional expertise from a pharmacist's perspective to help develop the critical piece of this plan-managing medications of patients with chronic disease.

Bryte Johnson, Government Relations Director, American Cancer Society, Cancer Action Network (ACSCAN): People with cancer often suffer not only from the disease, but also from pain, nausea, shortness of breath, anxiety and other symptoms in their struggle to get well. ACSCAN requests that Section 1 of the bill be amended to include the Palliative Care Advisory Council among the groups to be consulted with in the development of this chronic care plan. Treating the whole patient is key to extending life and enhancing the quality of the time gained. Palliative care is appropriate at any age and any stage of a serious or chronic illness.

The passage of HB 5386 will lead patients and families having more control and choice about treatment options and will encourage more informed and shared decision making.

Barbara Katz, Director, Clinical Program Development, VNA Community Healthcare (VNACHC): Any state initiative to prevent and control chronic illness should maximize efficiency utilizing existing community resources. Medicare Certified home health care agencies, particularly nonprofits, are such a resource.

Home health care agencies already have existing programs to perform screenings, teach exercise programs to improve patient's health, educate patients how to give and get medical information from medical visits, overall chronic disease education to reduce the number of readmissions to hospitals, and assess how a patient and family function at home and coordinate the primary care physician.

The initiative will be more effective and less costly if existing programs from certified home care agencies are incorporated into the new statewide program.

NATURE AND SOURCES OF OPPOSITION:

None

Reported by: Lori Littmann

Date: 3/12/2014