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Federal Agency Updates


>>OKAY.
WE’RE GOING TO NOW MOVE ON, LUNCH IS ALMOST HERE BUT NOT
QUITE. WE’RE GOING TO MOVE ON TO
FEDERAL AGENCY UPDATES, AND WE’RE GOING TO START WITH YOU,
RICHARD, I BELIEVE. AND WE’LL PASS TO YOU.
>>THANK YOU FOR THE CHANCE TO PRESENT.
SO THIS IS THE SESSION OF THE YEAR WHEN WE PRESENT THE ANNUAL
BYPASS BUDGET AND THE PROCESS THAT LEADS TO IT.
MANY OF YOU WILL BE AWARE BUT I’LL TRY TO GO THROUGH THE
PROCESS AGAIN. SO THE PROCESS OF IDENTIFYING
MILESTONES FOR PROGRESS IS FED BY INPUT FROM PROFESSIONALS,
NATIONALLY AND NATIONALLY GLOBALLY, INCLUDING BUT NOT
LIMITED TO THE SUPPLEMENTS THAT HAVE BEEN GOING ON SINCE 2012.
THE MOST RECENT SOURCES OF INPUT WERE FROM 2017, THE MOST RECENT
CARE SERVICES SUMMIT, 2018, THE A.D. SUMMIT, AND THE A.D. R.D.
RECOMMENDATIONS THAT CAME EARLIER THIS YEAR ARE WORKING
THEIR WAY THROUGH FOR PRESENTATION TO THE NINDS
COUNCIL AND THEN WILL BECOME A PART OF FUTURE PLANNING.
SO REMIND YOU, THE OPPORTUNITIES EXIST HAVE PROVIDED EXTENSIVE
INPUT FROM PRIVATE SECTOR, INDUSTRY, ACADEMIA, ALL THESE
ARE THEN DEVELOPED AT NIH WITH COLLABORATION ACROSS MULTIPLE OF
THE INSTITUTES FOR IDENTIFICATION OF RESEARCH
PRIORITIES AND THE MILESTONES NECESSARY TO ACHIEVE THOSE
PRIORITIES. WE THEN IDENTIFY THE COST
NECESSARY TO ACCOMPLISH ALL THESE MILESTONES AND THEY
ACCUMULATE INTO A BYPASS BUDGET. SO —
>>SORRY, I HEAR EVERYONE SHUFFLING PAPERS.
YOU DON’T HAVE A COPY OF THIS PRESENTATION.
>>IT’S COMING.>>IT WAS EMBARGOED.
THAT’S WHY IT’S NOT IN YOUR PACKET.
>>IT’S EMBARGOED UNTIL THIS VERY MOMENT.
[LAUGHTER] IT’S MAKING ITS WAY ACROSS THE
TABLE NOW AS WE SPEAK. SO TO EMPHASIZE, THERE ARE
BYPASS BUDGETS SORT OF ASPIRATIONAL AND THAT COME FROM
INFORMED BUT INFORMAL PROCESSES. THIS HAS BEEN OUR ATTEMPT FROM
THE BEGINNING TO MAKE THIS AS TOUCHED TO REALITY AS WE
POSSIBLY CAN. THE FINAL BUDGET YOU’RE SEEING
IS THE ESTIMATE FOR 20-21. SO THIS COMES FROM THE
CONGRESSIONAL LANGUAGE WHICH STIPULATES THAT EACH YEAR
THROUGH 2025, THE DIRECTOR OF NIH, NOW FRANCIS COLLINS, IS
REQUIRED TO SUBMIT TO CONGRESS AFTER AN OPPORTUNITY FOR COMMENT
BUT OPPORTUNITY FOR RE — AN ESTIMATE OF THE RESOURCES NEEDED
EACH YEAR IN ADDITION TO CURRENT OR PREVIOUS RESOURCES, TO
ACCOMPLISH MAXIMAL EFFICIENCY AND SPEED THE GOALS OF THE
NATIONAL PLAN. THE LIST HERE IS OF THE MULTIPLE
INSTITUTES AT NIH, 18 INSTITUTES AND CENTERS HAVE BEEN PART OF
PROVIDING INPUT INTO THE PROCESS, SO IT REALLY IS
NIH-WIDE. IT’S ORGANIZED AROUND A COMMON
ALZHEIMER’S DISEASE RESEARCH ONTOLOGY, DETAILS LAST RELATED
DEMENTIA RESEARCH IN GREAT DETAIL AND IS THE ORGANIZING
PRINCIPLE FOR CORRESPONDING GOALS AND MILESTONES.
THIS THEN IS WHAT YOU’RE SEEING FOR THE FIRST TIME AS IT IS NOW
BEING FORMALLY COMMUNICATED TO CONGRESS WITH OPPORTUNITY FOR
COMMENT INCLUDING BY ALL OF YOU, SO WE HAVE THE MAJOR CATEGORIES
USED AS A THEME FOR IDENTIFYING ONCE AGAIN THE INCREMENTAL
RESOURCES NEEDED. THE BASE WE USE, THIS WILL BE
IMPORTANT FOR THE CALCULATION, IS OVER THE CURRENT FY 19 BUDGET
WHICH IS THE ONLY PRESUMPTION WE CAN MAKE FOR WHAT WOULD BE THE
2020 BUDGET, SO IT’S ABOVE 2020, WHICH WE ASSUME TO BE FLAT TO
2019, HOW MUCH ADDITIONAL RESOURCE NEEDED FOR 2021.
SO THIS IS, AGAIN, THE 2021 BYPASS OR PROFESSIONAL JUDGMENT
BUDGET. YOU CAN SEE THAT THE TOTAL OF
THOSE NUMBERS IS SOME ADDITIONAL $438 MILLION BUT THIS YEAR FOR
THE FIRST TIME WE’RE RECOGNIZING BECAUSE IT OCCURS IN THE MAJOR
COMPONENT WHAT HAS TO BE A PART OF THE PROCESS THAT IS WHICH ARE
NOT SIMPLY ASKING FOR ADDITIONAL FUNDS PRESUMING THAT NOTHING
WHAT WAS FUNDED IN PREVIOUS YEARS HAS BECOME AVAILABLE FOR
DIRECTED NEW AREAS OF RESEARCH. YOU’LL REMEMBER THAT FIVE YEARS
AGO, FIVE YEARS BEFORE THE 2021, WAS REALLY THE BEGINNING OF THE
LARGE INCREASES IN APPROPRIATION.
SO FROM CALCULATIONS WHICH I’LL MENTION IN CONCEPT AND NOT GO
THROUGH IN DETAIL, WE ESTIMATE THE RESOURCE THAT WERE INVESTED
IN PREVIOUS YEARS THAT NOW WILL BECOME AVAILABLE IN 2021, THAT’S
ABOUT $84 MILLION SO THEREFORE THE ADDITIONAL FUNDS WE NEED
ABOVE A FLAT FY 19 BUDGET PRESUME IN 2020 IS $354 MILLION.
THAT’S THEN THE REQUEST FOR THE FY 2021 BYPASS BUDGET.
THIS IS A BREAKDOWN OF WHAT YOU’VE SEEN IN THE TABLE, NOW
SHOWN AS A PIE DIAGRAM. WE CAN COME BACK TO ANY OF THESE
FOR MORE PERSPECTIVE. THERE’S ANOTHER WRINKLE HERE,
THE STANDING BUDGET FOR FY 20 IS THE PRESIDENT’S BUDGET, WHICH AS
MANY OF YOU WILL RECALL CALL FOR SUBSTANTIAL DECREASE IN BUDGET
ACROSS ALL OF NIH. THIS IS WHAT IT TRANSLATES INTO
THE DECREASE THAT THE PRESIDENT HAS PROPOSED FOR ALZHEIMER’S
RESEARCH, THEREFORE IN 2020. SO I MENTIONED OUR BYPASS BUDGET
IS BASED ON A PRESUMPTION OF A FLAT BUDGET IN 2019 AS THE BASE
IN 2020. IF WE NOW CONNECT WITH WHAT HAS
BEEN REQUESTED ABOVE THE PRESIDENT’S BUDGET IN — IT IS
INCREASED BY THAT PROPOSED DECREASE OF $326 MILLION, BUT
THE $353 MILLION PROPOSED INCREASE WOULD LEAD MOST
IMPORTANT BOTTOM LINE NUMBER TO WHAT WOULD THEN BECOME A TOTAL
INVESTMENT IN NIH RESEARCH OF $2.8 BILLION IN FY 2021.
JUST TO SHOW YOU NOW WHAT’S BEEN HAPPENING OVER THE YEARS, THIS
IS ANIMATED, BUT YOU GET THE PICTURE WHEN WE LOOK AT IT
COMPLETED. THIS IS A PICTURE OF WHAT’S
HAPPENED EACH YEAR BEGINNING WITH THE FY 17 MILESTONES AND
FY — THE BYPASS BUDGET FOR FY 17 RELEASED IN 2015 PROPOSED AN
INCREASE OF $350 MILLION. NEXT YEAR WE PROPOSE
$400 MILLION, AND CONGRESS APPROPRIATED $414 MILLION
BUDGET. $414 MILLION PROPOSAL WAS
$597 MILLION PROPOSAL RATHER WAS FOLLOWED BY 414, $478 MILLION
PROPOSAL IN THE FY 20 BUDGET FOLLOWED BY A $425 MILLION THIS
YEAR, THIS CURRENT YEAR, FISCAL FY 19, AND NOW THE ADDITIONAL
BOX YOU SEE HERE IS THIS YEAR’S PROPOSAL FOR $354 MILLION
INCREASE IN 2021, AND OF COURSE REMAINS TO BE SEEN WHAT WILL BE
THE FY 20 BUDGET AND THEREAFTER IN SUBSEQUENT YEARS.
SO THIS IS IT, THE EMBARGO IS OVER, AND HAPPY TO DISCUSS THE
PROCESS OR THE OUTCOME FOR YOU, BUT AGAIN, CAN’T HELP BUT
MENTION THAT WHAT YOU’VE SEEN IN TERMS OF RESEARCH PROGRESS AND
INVESTMENT HAS BEEN ENORMOUSLY DEPENDENT UPON THESE INCREASES
WHICH WERE UNPRECEDENTED. IT’S HARD, EVEN DEPRESSING FOR
ANY OF US TO IMAGINE WHAT THE SITUATION WOULD BE LIKE IN TERMS
OF RESEARCH IF WE WERE WHERE WE WERE BACK BEFORE THESE INCREASES
BEGAN IN FULL FORCE IN FY 16. IT’S BEEN EXTRAORDINARY.
SO OPEN TO QUESTIONS IF THERE’S TIME AND INTEREST.
>>QUESTIONS?>>COULD YOU GO BACK TO THE
SLIDE THAT HAS THE CIRCLE WITH THE PERCENTAGES OF FUNDING?
YES. AND I WAS JUST WONDERING HOW YOU
DECIDE UPON THESE KINDS OF ALLOCATIONS.
>>SO AGAIN, IT’S NO PRESUPPOSITION, WE DIDN’T DECIDE
WHAT PERCENT SHOULD BE ALLOCATED TO ANY ONE AREA.
RATHER WE TOOK ALL OF THE RECOMMENDATIONS, SO FOR EXAMPLE
THE RECENT RECOMMENDATIONS FROM 2017, CARE AND SERVICES, 2018,
ALZHEIMER’S DISEASE SUPPLEMENTS, ALL OF THOSE CONSTRUCTED OVER
THE YEARS, PRIORITIES AND MILESTONES.
WE LOOKED AT EVERY MILESTONE, DIDN’T REMOVE ANY, DIDN’T
PRIORITIZE ANY, SIMPLY DETERMINED WHAT WOULD BE
NECESSARY TO ACCOMPLISH THOSE MILESTONES AND ADD THEM UP, SO
THIS IS THE BOTTOM UP. THERE IS ONLINE A SET OF THOSE
MILESTONES THAT YOU CAN TAKE A LOOK AT TO SEE WHERE THEY CAME
FROM, BUT IT’S NO PRESUPPOSITIONS, IT’S WHAT’S
NECESSARY TO ACCOMPLISH ALL PRIORITIES RAISED IN EACH
SUMMIT. SO NEXT YEAR WE’RE LOOKING
FORWARD AS YOU KNOW TO THE 2020 CARE AND SERVICES SUMMIT ONCE
AGAIN, THERE WILL BE A NEW SET OF RECOMMENDATIONS, THEY’LL
GENERATE MILESTONES, THEY’LL BECOME A PART OF THE MILESTONES
EACH YEAR, WHAT IT WILL TAKE TO ACCOMPLISH THOSE.
>>THANK YOU. SO CAN I ASK FOR THE
TRANSLATIONAL RESEARCH AND CLINICAL INTERVENTIONS, THAT
REFLECTS THE HIGHEST PERCENTAGE. DOES THAT REFLECT THE MOVEMENT
OF THE FIELD AND GOING BACK TO YOUR PREVIOUS PRESENTATION THAT
WE’RE KIND OF READY NOW TO TAKE SOME OF THE BASIC DISCOVERY AND
MOVE IT INTO A TRANSLATIONAL RESEARCH?
DO YOU SEE WHAT I MEAN?>>YES.
IT SAYS THERE ARE MANY OPPORTUNITIES HERE TO BE FUND
AND CAN BE FUNDED INTO CLINICAL STUDIES.
>>SO IT REFLECTS A CHANGE IN THE FIELD IN A WAY.
>>>>THAT’S RIGHT.
IN TERMS OF THE DIVISION OF THIS COUNCIL AND WORK GROUPS, IT’S
NOT A PRECISE CORRESPONDENCE BECAUSE CARE AND CAREGIVER
SUPPORT RESEARCH WILL HAVE ITS OVERLAPS INTO TRANSLATIONAL
RESEARCH AS WELL, SO AGAIN, I’D URGE ANY OF YOU INTERESTED TO
TAKE A LOOK AT HOW THE MILESTONES ARE LAID OUT FOR EACH
OF THESE.>>THANK YOU VERY MUCH.
ANY OTHER QUESTIONS? THANKS.
>>THANKS, RICHARD. A FEW OF THEM REALLY ARE
IMPORTANT TO BRINGING THE FIELD FORWARD FOR SURE.
IF YOU CAN GO FORWARD TO THE SLIDE YOU HAD THAT WAS ANIMATED?
THE QUESTION I HAVE IS SOME YEARS THERE HAVE BEEN REQUESTS,
WHAT’S BEEN AWARDED HAS NOT BEEN REQUESTED, LIKE THERE’S BEEN 597
THAT WAS REQUESTED ONE YEAR BUT IT RESULTED IN — I CAN’T
REMEMBER THE SPECIFIC NUMBER.>>SO THE CAUSE AND EFFECT,
ALLAN, IS THAT –>>I GUESS THE QUESTION I HAVE,
HOW WERE THOSE GAPS TRANSLATED INTO WHERE THE MONEY ACTUALLY
GOES? SO IF IT WAS DETERMINED THAT
$597 MILLION IS NEEDED, AND ONLY 414 IS PROVIDED, WHERE ARE THOSE
GAPS?>>SO AT ANY TIME IMPORTANT TO
DISTINGUISH THE MILESTONES WHICH ARE ESTIMATES REALLY A YEAR TO
TWO YEARS BEFORE THE BUDGET ACTUALLY OCCURS FROM SCIENTIFIC
OPPORTUNITIES WHICH THEN RESULT. SO AT A PRACTICAL LEVEL, AS YOU
WELL KNOW, RESEARCH IS SUPPORTED IF WE BREAK IT DOWN TO
CATEGORIES TO INVESTIGATOR SUPPORTED RESEARCH, SPECIFIC
SETASIDE OF FUNDS FOR PARTICULAR PURPOSE, THERE ARE THE SETASIDES
TARGETED. FUNDING IS DETERMINED FROM THE
BALANCE OF THOSE TWO. FROM THESE MILESTONES, WE’LL
OFTEN IN CASES WHERE IT’S DEEMED TO BE NECESSARY BUT NOT
NECESSARILY ON EVERY ONE SET ASIDE SPECIALIZED FUNDING AMOUNT
FOR A PARTICULAR PROJECT. THAT DOESN’T NECESSARILY
CORRESPOND TO WHAT WAS USED TO BUILD INTO THE MILESTONE.
SO THE CORRESPONDENCE BETWEEN THESE BROAD CATEGORIES OF
MILESTONES AND INITIATIVES TO CARRY FORWARD THE RESEARCH
ITSELF IS NOT ONE TO ONE. WHAT I WOULD SAY IF THIS IS A
USEFUL WAY TO CHARACTERIZE WHAT’S HAPPENED IS WITH THE
LEVEL OF INCREASE WE’VE HAD, OUR SOLICITATIONS TO THE PUBLIC, THE
GRATIFYING EXPANSION IN SCIENTIFIC OPPORTUNITIES,
INVESTIGATED INCLUDING NEW INVESTIGATORS, WE’VE BEEN ABLE
AT THIS LEVEL OF GROWTH TO SUPPORT AS YOU’VE SEEN AND IS
QUITE PUBLIC PAYLINES FOR INVESTIGATOR INITIATED RESEARCH
IN THE RANGE OF 26, 28 PERCENTILES AND SIMILARLY FOR
THE RESPONSES TO OUR TARGET INITIATIVES, WHICH ARE VERY
CLOSE TO THE LEVEL THAT MANY IN THE FIELD WOULD SAY IS ABLE TO
SUPPORT OF A LARGE MAJORITY OF OUTSTANDING RESEARCH.
WE’RE NOT I WOULD SAY SUPPORTING ANYTHING THAT ISN’T OUTSTANDING
BUT WE’RE REALLY TO A GRATIFYING LEVEL BE ABLE TO SUPPORT THE
APPLICATIONS THAT COME IN WHICH ARE OUTSTANDING TOWARDS ALL OF
THESE RESEARCH GOALS. SO IT’S A LONG WAY AROUND WHY
ISN’T THERE A $1 TO $1 CORRESPONDENCE, BUT REMEMBER
THERE’S A TIME DIFFERENCE TOO FROM WHEN WE PUT FORWARD, THE
BYPASS BUDGET GOES FORWARD FOR 1920-21.
CONGRESS MAY OR MAY NOT FIND THAT’S INFLUENTIAL IN DECIDING
WHAT THEY’RE GOING TO APPROPRIATE FOR 2020, WHICH IS
THEN GOING TO ACCELERATE WHAT WE SAY WERE THE 2021 GOALS.
BY THE TIME WE REALLY GET TO 2021, WE’LL BE DEALING WITH
HOPEFULLY UNDERSTANDING MILESTONES THAT GO BEYOND WHAT
WE NOW IN 2019 ARE SAYING ARE THE 2021 SPECIFIC RESEARCH
PROJECTS.>>THANK YOU.
>>BRAD?>>THAT ANSWER WAS AS CLEAR AS
COULD BE. [LAUGHTER]
[INAUDIBLE] IT MAY BE PREMATURE BUT FROM WHAT I CAN GATHER,
CONGRESS ACTUALLY AGREED ON SOME BUDGET THINGS IN THE PAST COUPLE
OF DAYS. YOU TALKED ABOUT THE PRESIDENT’S
BUDGET AND LOOKING FORWARD, IT LOOKS LIKE THERE MIGHT BE TWO
YEARS OF FUNDING SORT OF OUT? I LOOK FORWARD TO YOUR COMMENTS
OF HOW THAT IMPACTS THIS.>>FIRST AND IMPORTANT, I HOPE
IT WAS CLEAR, THIS IS A PROFESSIONAL JUDGMENT PROPOSAL
OR BUDGET THAT’S QUITE SEPARATE FROM THE APPROPRIATIONS PROCESS.
WHAT YOU’VE HEARD AND OF COURSE I KNOW NO MORE THAN YOU IS THE
PROSPECT FOR AGREEMENT ON A BUDGET CAP AND THEREFORE THE
ABILITY TO COME TO A TWO-YEAR BUDGET OVER THE NEXT COUPLE OF
YEARS, THIS IS OPTIMISTIC NEWS FOR EVERYONE WHO WAS HOPING
THERE WILL BE APPROPRIATIONS FORTHCOMING WITHOUT DELAY IN THE
NORMAL PROCESS, BUT IT SAYS NOTHING ABOUT WHAT PRIORITIES
WILL BE, WHAT’S ACTUALLY ALLOCATED TO DIFFERENT PARTS OF
THAT BUDGET. SO HAVING FUNDING LOOKING AS
THOUGH IT’S GOING FORWARD IS NECESSARY BUT NOT — WE HAVEN’T
SEEN AS YOU KNOW THE MARKS COMING FROM HOUSE OR SENATE AND
THEN WHAT THE PRESIDENT IS GOING TO DO THAT — I THINK IT’S FAIR
TO SAY FOR EVERY PRESENTATION WE’VE HAD, THANKS A LOT TO THE
WORK THAT YOU’RE ACCOMPLISHING. THERE’S CONTINUES TO BE GREAT
BIPARTISAN, BICAMERAL SUPPORT FOR NIH RESEARCH AND FOR
ALZHEIMER’S RESEARCH AS WELL, BUT UNCLEAR WHETHER IT WILL
FOLLOW THIS PATTERN OR NOT. THIS YEAR FOR THE VERY FIRST
TIME, WE HAD A BUDGET WHEN THE FISCAL YEAR BEGAN, AND THAT’S
NOT HAPPENED IN OUR MEMORIES, AND I DON’T KNOW IF WE’LL HAVE
THIS HAPPEN AGAIN, BUT BEFORE LONG, WE’LL KNOW.
AND YOUR STATEMENT, CLEAR AS COULD POSSIBLY BE, I TAKE TO
MEAN EXACTLY WHAT YOU SAID. [LAUGHTER]
>>[INAUDIBLE]>>IT DESCRIBES THE LIMITATIONS
IN THE PROCESS.>>THANK YOU.
IT’S STILL VERY CLEAR. THANK YOU VERY MUCH.
WE’RE GOING TO GO ON TO YOU, SHERRY, AND COULD YOU PASS THE
CLICKER DOWN.>>THANK YOU.
>>THESE ARE NOT MY SLIDES.>>JUST TO COMPLETE, LOST IN THE
DRAMA OF THE EMBARGO THERE. [LAUGHTER]
>>I WAS ALLUDING TO THE RESOURCES THAT ARE AVAILABLE
ONLINE FOR THOSE OF YOU WHO WANT TO GO PROBING INTO THE SET OF
INITIATIVES. WE ALSO WOULD WELCOME INPUT ON
IT TOO. IN TERMS OF THE CONSIDERATIONS
FOR FUTURE BUDGETS, CONVERSATION WE’VE ALREADY HAD, THE PAST AND
CURRENT APPROPRIATIONS ARE INCLUDING FUNDS THAT HAVE
ALLOWED US TO MOVE FORWARD ON MILESTONES OFTEN IN ADVANCE, SO
WE HAVE A BYPASS BUDGET THAT GOES OUT, WE GET AN
APPROPRIATION, THAT APPROPRIATION ACTUALLY LETS US
DO THINGS PROPOSED IN THE BYPASS BUDGET AND DO THEM SOONER THAN
EXPECTED. SO ALL THIS GOES INTO THE FUTURE
PLANNING YEAR BY YEAR. I ALSO MENTIONED FOR THE FIRST
TIME, THE FACT THAT THE FUNDING FROM PRIOR APPROPRIATIONS HAS
BECOME AVAILABLE BECAUSE OF THE TASKS OR MILESTONES
ACCOMPLISHED, REDUCING THE ACTUAL AMOUNT OF INCREMENTAL OR
NEW FUNDS THAT WE NEED, AND I HAVE TO SAY, AS I ALLUDED TO,
WE’RE ABLE TO — AS A CONGRESS THAT APPROPRIATELY — COMES FROM
CONGRESS EVERY TIME, WE’VE HAD THESE INCREASES, ARE YOU REALLY
ABLE TO USE THEM APPROPRIATELY AND EFFECTIVELY AND THE ANSWER
HAS BEEN YES, WE HAVE HAD INCREDIBLE RESPONSE FROM THE
FIELD, AS WELL AS YOU SAW FROM OUR DATA EARLIER TODAY IN
RECRUITING PEOPLE NEW TO THE FIELD, SO WE’RE AT A POINT WHERE
WE’RE ABLE TO BE REASSURING TO OURSELVES, TO THE PUBLIC, TO
CONGRESS, THAT THESE VERY DRAMATIC INCREASE IN FUNDS HAVE
ALLOWED OUTSTANDING RESEARCH THAT’S REALLY ACCELERATING THE
PROCESS TOWARDS OUR GOALS. THIS ALLUDED TO SPECIFIC DATES
FOR THE 2020 CARE AND SERVICES SUMMIT MARCH 24, 25, ON THE NIH
CAMPUS, SOON WE’LL BE ANNOUNCING WHEN REGISTRATION WILL OPEN, I
HOPE MANY OF YOU AS IN THE PAST ARE ABLE TO ATTEND, IT’S BEEN A
GREAT RESOURCE IN INFORMING OUR PRIORITIES.
THE STEERING COMMITTEE FOR THAT 2020 SUMMIT IS ILLUSTRATED HERE.
JENNIFER WULF AND DAVID RUBEN AS CO-CHAIRS HAVE BEEN WORKING WITH
NIH STAFF AND A NUMBER OF YOU ON THIS COUNCIL AS WELL TO PUT
TOGETHER THIS STEERING COMMITTEE, SO PLANNING FOR THE
MEETING IS ALREADY WELL UNDERWAY, AND I THINK THERE WILL
BE ANOTHER EXCITING OPPORTUNITY TO HAVE A SENSE OF WHAT PROGRESS
HAS BEEN MADE AND WHAT ADDITIONAL RESEARCH IS NECESSARY
IN THIS FIELD. AND THERE WE GO.
>>AS THE CLICKER COMES UP TO ME, I THINK JUST SEEING THE
PROGRESS AND THE AMOUNT THAT’S DEDICATED TO TRANSLATIONAL
RESEARCH ALSO SPEAKS TO THE OPPORTUNITY TO ACTUALLY DO THAT.
TRANSLATE RESEARCH INTO POLICY, CLINICAL ACTIONS, AND IN ORDER
TO DO THAT, ONE CHALLENGE IS TO CLEARLY DELINEATE WHAT THE
OUTCOMES ARE, THAT TRIALS FOCUS ON, THAT CLINICAL PRACTICE CAN
FOCUS ON AND ALSO POLICY. SO WE EAGERLY AWAIT THE EMERGING
EVIDENCE FOR PURPOSES OF BEING ABLE TO INTEGRATE WHAT WE LEARN
INTO FUTURE PROGRAMS AND POLICIES AND JUST AS A HIGH
LEVEL, I’M GOING TO COVER SOME OF THE RECENT DEVELOPMENTS AGAIN
THINKING ABOUT THE SYSTEM, FOCUSING ON THE SYSTEM THE
OPPORTUNITIES FOR PROGRAMS AND POLICIES THAT ARE INTENDED TO
IMPROVE CARE AND SERVICES TO PEOPLE WHO HAVE DEMENTIA, THOSE
AT RISK OF DEMENTIA AND ALSO THEIR FAMILY MEMBERS AND CARE
PARTNERS. ONE OF THE IMPORTANT PRIORITIES,
A VERY HIGH PRIORITY FOR THE CMS ADMINISTRATOR IS THIS INITIATIVE
CALLED THE PATIENTS OVER PAPERWORK INITIATIVE.
AND THROUGH THIS INITIATIVE, WE ACTUALLY HAVE DELINEATED THE
CARE JOURNEY, CARRY WAS MENTIONING EARLIER, CARE
NAVIGATORS BUT THE CARE JOURNEY FROM THE PERSPECTIVE OF THE
PEOPLE WHO RECEIVE THE SERVICES THOSE WHO DELIVER CARE AND
SERVICES INCLUDING A NURSING HOME JOURNEY MAP, WHAT THE
POTENTIAL IMPEDIMENTS ARE, ADMINISTRATIVE IMPEDIMENTS TO
DELIVERING THE CARE AND SERVICES AND RECEIVING THE CARE AND
SERVICES THAT ACTUALLY TRANSLATE INTO BETTER OUTCOMES.
ONE OF THESE RECENT DEVELOPMENTS IS WE HAVE AN RFI OUT ON THE
STREET THAT REALLY FOCUSES ON PRIOR AUTHORIZATION
REQUIREMENTS, AND OTHER ELEMENTS THAT ARE NOTED HERE.
WE’RE LOOKING FOR WHAT IS IT THAT MAKES CARE HARD, SO WE CAN
THINK ABOUT HOW DO WE STREAMLINE THE REQUIREMENTS SO THAT REALLY
WHAT CAN RESULT IS THAT THE SERVICES PROVIDED, THERE CAN BE
MORE MEANINGFUL TIME AND EXCHANGE BETWEEN CLINICIANS AND
THE PEOPLE WHO THEY SERVE. SO THIS IS ACTUALLY OPEN FOR
PUBLIC COMMENT AND ELLEN HAS KINDLY ANNOTATED THE PROVIDED
LINKS TO THE FEDERAL REGISTER NOTICE WHICH WILL INCLUDE HOW
YOU CAN ACTUALLY COMMENT. SO IN ADDITION, WE RECENTLY
PUBLISHED A FINAL RULE UPDATING AND MODERNIZING THE PACE
REQUIREMENTS, PROGRAM FOR ALL INCLUSIVE CARE FOR THE ELDERLY,
SO THIS SERVICE, THIS PROGRAM PROVIDES COMPREHENSIVE CARE,
BOTH MEDICAL AND SOCIAL, TO PEOPLE WHO ARE AT HIGH RISK OR
WHO ACTUALLY WOULD QUALIFY FOR NURSING HOME PLACEMENT, AND THIS
RULE ACTUALLY FINALIZES TO STRENGTHEN BENEFICIARY
PROTECTION, IMPROVING CARE COORDINATION, ADMINISTRATIVE
FLEXIBILITIES AND REGULATORY RELIEF FOR PACE ORGANIZATIONS SO
AGAIN, THIS IS IMPORTANTLY PACE SERVICE RECIPIENTS ARE MANY WHO
ARE DULY ELIGIBLE, SO MEDICAID AND MEDICARE PROBABLY
REPRESENTING SOME OF THE MOST VULNERABLE PEOPLE WHO WE SERVE
THROUGH CMS. WE’VE HAD ALSO SOME PROGRESS IN
THE AREA OF QUALITY MEASUREMENT AND FOCUSING ON WHAT QUALITY
LOOKS LIKE FOR PEOPLE WITH COMPLEX CARE NEEDS.
JUST IN JULY, WE HAVE HOSTED WEBINARS ANNOUNCING SEVERAL NEW
MEASURES IN THE INNOVATION ACCELERATED PROGRAM IN MEDICAID,
INCLUDING A MEASURE THAT IS FOCUSING ON NEWLY PRESCRIBED
ANTIPSYCHOTIC MEDICATIONS. IT’S NOT REALLY A
DEMENTIA-SPECIFIC MEASURE PER SE, AND JUST THINKING ABOUT
PEOPLE AGAIN AS OPPOSED TO THE DISEASE, SO IT REALLY IS AN
OPPORTUNITY TO, THROUGH QUALITY, BE ABLE TO RE-LOOK AT WHAT CARE
AND SERVICES ARE PROVIDED, AND AS A REFLECTION, ANTIPSYCHOTIC
AND OTHER MEDICATION PRESCRIBING.
SO THIS IS AT THE LEVEL OF STATE USE, NOT INDIVIDUAL PROVIDER
USE, BUT THERE ARE, AS YOU KNOW, OTHER QUALITY MEASURES THAT
FOCUS ON ANTIPSYCHOTIC PRESCRIBING.
I’LL MENTION A LITTLE BIT ABOUT THAT LATER.
IN PRIOR MEETINGS, I ALSO — WE’VE BEEN ALL TRACKING THE
INDEPENDENCE AT HOME MODEL, AND NOW WE HAVE THE YEAR FOUR
EVALUATION RESULTS ON THE INNOVATION CENTER WEBSITE.
OVERALL, IAH SAVED MEDICARE APPROXIMATELY 33 MILLION IN YEAR
4 OR ABOUT $384 PER ENROLLED BENEFICIARY PER MONTH, SO THIS
FOLLOWS THE SAVINGS OBSERVED IN YEARS 1 TO 3.
THE RESULTS ACTUALLY ATTEST TO THE VALUE OF HOME BASED PRIMARY
CARE IN FRAIL OLDER ADULTS WITH AN EMPHASIS ON —
EMPHASIS ON CONTINUITY OF CARE.
NOW, OVERALL IN YEAR 4, THIS ALSO RESULTED IN 1800 FEWER
HOSPITAL ADMISSIONS, MORE THAN 3,000 FEWER EMERGENCY DEPARTMENT
VISITS AND 400 FEWER UNPLANNED READMISSIONS.
SO AS FAR AS ADMINISTRATIVE METRICS, CERTAINLY THIS TYPE OF
CONTINUITY IS PROVING ITS WORTH. WHEN YOU LOOK AT THE DATA FROM
THE PERSPECTIVE OF DIAGNOSIS OF DEMENTIA, THE POPULATION WITH
VERSUS WITHOUT, THE BENEFITS ARE PRETTY SIMILAR ACROSS BUT AGAIN
THINKING ABOUT THE CAVEATS, HOW DO YOU GET A DIAGNOSIS OF
DEMENTIA AND THAT IS A VERY LONG AND ARDUOUS JOURNEY IN AND OF
ITSELF. SO IT LOOKS SIMILAR BUT THE GOOD
NEWS IS BENEFITS WERE REALLY OBSERVED AND COST SAVINGS AS
WELL. THERE ARE SEVERAL PRIMARY CARE
AND NEW MODELS THAT THE INNOVATION CENTER HAS BEEN
PUTTING FORTH AND IN APRIL, THERE’S A PRIMARY CARE FIRST
MODEL THAT WAS ANNOUNCED. THE PURPOSE OR THE INTENT IS TO
ENABLE BETTER COMMUNICATION BETWEEN CLINICIANS AND THE
PATIENTS WHO THEY SERVE, ENHANCING THE CARE NEEDS AND
SERVICES TO THOSE WITH COMPLEX NEEDS, INCLUDING SERIOUSLY ILL
PEOPLE, AGAIN ALSO ALLEVIATING SOME OF THE ADMINISTRATIVE
BURDEN, AND SO IN 2020, IT’S BEEN NOTED THIS MODEL WILL APPLY
TO 26 DIVERSE REGIONS ACROSS THE COUNTRY WHO ARE CURRENTLY NOT
PARTICIPATING IN CPC PLUS, SO FOR THE INNOVATION CENTER
PURPOSES, THIS IS A PROGRAM, A MODEL THAT HAS TO BE TESTED IN
AND OF ITSELF SO NOT TO HAVE INFLUENCE OR CONFOUNDING BY
PARTICIPATION IN OTHER CARE MODELS.
SO THIS IS TRYING TO SET THE STAGE FOR A PURER EVALUATION.
THIS MODEL HAS ELEMENTS THAT ARE SPECIFICALLY DESIGNED TO SUPPORT
PRACTICES INCLUDING CARING FOR PEOPLE WITH COMPLEX NEEDS AND
SERIOUS ILLNESS. SO MODEL EDUCATION MODULES AND
WEBINARS ARE ACTUALLY AVAILABLE THROUGH THE LINK PROVIDED HERE.
I KNOW THIS SESSION IS ABOUT CLINICAL SERVICES AND NOT
NECESSARILY LONG-TERM CARE. I KNOW DEBRA IN THE
RECOMMENDATIONS WILL BE ADDRESSING SOME OF LONG-TERM
CARE AND WE’LL BE HEARING MORE ABOUT THIS, BUT THERE HAVE BEEN
SEVERAL PROPOSALS OF NOTE AND FINALIZATION OF SEVERAL POLICIES
IN THE LONG-TERM CARE SPACE. THIS IS ONE SPECIFIC TO
ARBITRATION AGREEMENTS AND FINALIZING THE AGREEMENTS AND
WHAT IS PERMITTED ON THE PART OF NURSING FACILITIES.
OVERALL, THIS AND OTHER RULES THAT ARE BEING PROPOSED, WE’RE
TRYING TO STRIKE THE RIGHT BALANCE BETWEEN THOSE WHO
PROVIDE THE CARE, WHICH IS THE FACILITIES AND ALSO WHAT IS IT
THAT THE RESIDENTS ACTUALLY NEED, SO STRIKING THAT SWEET
SPOT HAS BEEN CHALLENGING BUT WE’RE AIMING FOR BALANCE.
SO THIS IS ONE OF SEVERAL ROLES THAT HAVE BEEN RECENTLY POSTED.
ALL IN ALL, THE OPPORTUNITIES I THINK THAT ARE AHEAD OF US WHEN
IT COMES TO INFRASTRUCTURE IS HOW DO WE MEASURE AS WE WERE
ALLUDING TO IN OUR PRIOR CONVERSATION AND IMPACT TO ACT
ACTUALLY PROVIDES US WITH OPPORTUNITY IN THE
STANDARDIZATION OF THE DATA ELEMENTS TO MEASURE IMPORTANT
THINGS SUCH AS DIAGNOSIS, COGNITIVE STATUS, FUNCTIONAL
STATUS, ACROSS POST ACUTE CARE SETTINGS.
NOW THIS PROVISION, THE IMPACT TO ACT ACTUALLY REALLY WAS FROM
POST ACUTE CARE AND STANDARDIZES MEASUREMENT ACROSS ACUTE CARE
SETTINGS, HOWEVER, THAT STANDARDIZATION OF DATA ELEMENTS
IS REALLY PREPARING THE SYSTEM TO BE ABLE TO ADOPT AND UPLOAD
INTO EHRS, SO COULD BE USED IN OTHER CARE SETTINGS INCLUDING
ACUTE CARE, INCLUDING INDIVIDUAL PRACTICES, BUT THE IMPACT ACT
DID NOT GIVE CMS AUTHORITY TO REQUIRE THAT THESE OTHER
SETTINGS USE THE WORK. SO IMPORTANTLY THESE ELEMENTS,
DUAL PURPOSE FOR MEASUREMENT FOR QUALITY, BUT ALSO FOR CARE
PLANNING. SO JUST REMINDING YOU THAT
THESE — THIS INFORMATION IS AVAILABLE AND INCLUDED IN THE
DATA ELEMENT LIBRARY, THE DEL, AS WELL AS THE REFERENCE AND
LINK PROVIDED HERE. SO AS FAR AS THE NATIONAL
PARTNERSHIP TO IMPROVE DEMENTIA CARE IN NURSING HOMES, WE HAD
RECEIVED WORD, THERE WAS A RUMOR THAT IT HAS GONE BY THE WAYSIDE
BUT IN FACT WE’VE BEEN CONTINUING THE WORK THAT
INITIALLY WE SET A GOAL OF REDUCING ANTIPSYCHOTICS USE IN
LONG STAY NURSING HOME RESIDENTS OF 30% REDUCTION BY THE END OF
2016, WHICH WE ACTUALLY HAVE MET.
WE’VE CONTINUED TO OBSERVE REDUCTIONS AND THEREFORE RESET A
GOAL, A NEW GOAL OF REDUCING ANTIPSYCHOTIC USE BASED ON MDS,
MINIMUM DATASET, OF 15% BY THE END OF 2019 FROM THE BASELINE OF
2011. SO AS YOU CAN SEE, WE ARE STILL
CONTINUING TO MAKE PROGRESS HERE, SO THAT PEOPLE ARE AWARE,
THIS WOULD TRACK TO ABOUT A NATIONAL PREVALENCE OF ABOUT 7%.
NOT ALL FACILITIES HAVE ACTUALLY MADE PROGRESS IN THIS WAY, SO
WE’VE BEEN TRACKING LATE ADOPTERS WHO HAVE EITHER
INCREASED THEIR PRESCRIBING OR HAVE NOT IMPROVED, AND THE
PREVALENCE IN THE LATE ADOPTER POPULATION OF FACILITIES IS
ABOUT 20%. SO THERE IS ROOM FOR
IMPROVEMENT. WE ALSO, THOUGH, RECOGNIZE THAT
THERE ARE INDICATIONS, APPROPRIATE INDICATIONS FOR THE
USE AND PRESCRIBING OF THESE MEDICATIONS, IMPORTANTLY
PRESCRIBING HAS TO BE VERY PERSON-CENTERED SO USING
NON-MEDICINAL INTERVENTIONS AS FIRST LINE AND WHEREVER
POSSIBLE, AND REALLY RELYING ON THE CLINICAL TEAM TO UNDERSTAND
AND NOTE WHAT EACH RESIDENT’S GOALS OF CARE ARE AND EACH
RESIDENT’S CARE NEEDS IN ORDER TO PRESCRIBE.
BUT THIS IS AN EXAMPLE OF HOW WE CAN USE DATA TOGETHER TO
IMPROVE. THIS IS NOT CMS ONLY, THIS IS A
NATIONAL EFFORT THAT CMS COULD NOT IMPLEMENT AND ACHIEVE THESE
TARGETS IF IT WEREN’T FOR OUR PARTNERS WHO ARE NON-FEDERAL OUT
THERE. WE HAVE MADE PUBLIC USE DATA
FILES AVAILABLE THAT INCLUDE ANTIPSYCHOTICS AND A VARIETY OF
OTHER MEDICATIONS. I THINK THIS GROUP OF
INVESTIGATORS AND RESEARCHERS AND POLICY MAKERS WOULD BE VERY
INTERESTED IN. IT CONTAINS A GREAT DEAL OF
INFORMATION INCLUDING AGGREGATED COSTS, UTILIZATION PATTERNS AND
THE LIKE, SO THIS PUBLIC USE DATASET WE HOPE WILL BE EXACTLY
AS THE NAME SUGGESTS, WHICH IS AVAILABLE AND UTILIZED BY THE
PUBLIC. JUST SO THAT YOU KNOW, WE HAVE
UPDATED OUR CHART BOOK FOR CHRONIC CONDITIONS IN CMS.
THIS COMES FROM MEDICARE FEE FOR SERVICE NOW I JUST CALL
ATTENTION TO THE LINE IN THE MIDDLE WHICH IS ALZHEIMER’S
DISEASE AND DEMENTIA, JUST TO POINT OUT THAT WE CONTINUE TO
TRACK THE PREVALENCE OF CLAIMS IN FEE FOR SERVICE THAT
ALZHEIMER’S OR DEMENTIA IS INCLUDED, BUT IF YOU NOTE, THE
PURPLE ON THE — SORRY, THE BLUE ON THE LEFT IS THE PERCENTAGE OF
THE POPULATION THAT ONLY HAS DEMENTIA COMPARED TO THE REST OF
THE LINE THAT HAS OTHER CONDITIONS, WHICH REALLY CREATES
THE BUSINESS CASE FOR WHY CLINICAL TRIALS THAT INCLUDE
MEDICARE BENEFICIARIES REALLY, REALLY MATTERS BECAUSE IT’S
OFTEN AT THE POINT OF CARE COMPETING DISEASES, DEMENTIA
WILL ACTUALLY PROVIDE A CHALLENGE AND A FILTER FOR THE
MANAGEMENT OF ANY OF THESE OTHER CONDITIONS.
SO THIS IS ACTUALLY ALSO MEANT JUST FOR PURPOSES OF CONTEXT ON
THE SCOPE AND SCALE AND IMPLICATIONS OF DEMENTIA ACROSS
THE BOARD. SO WITH THAT, I WILL TURN THIS
OVER TO LISA NOW? OH —
>>WE’LL TAKE ONE OR TWO QUESTIONS.
>>OKAY.>>THANK YOU.
THIS IS REALLY A GREAT PRESENTATION, SHARI.
SOMETHING I MENTIONED AT THE LAST MEETING, FOR MEDICARE
ADVANTAGE PROVIDERS NOW, CMS HAS A HIERARCHICAL CONDITION
CATEGORY WHICH GIVES YOU A RISK ADJUSTMENT IF YOU HAVE DEMENTIA.
SO THAT PROVIDERS CAN ACTUALLY BE PAID MORE WHEN THEY DIAGNOSE
SOMEONE AS HAVING DEMENTIA, WHICH MEANS THAT THEY MIGHT HAVE
SOME MORE MOTIVATION, I MEAN, IT’S JUST ONE OF THE THINGS THAT
INCREASES THE LIKELIHOOD OF DIAGNOSIS.
SO THERE’S HCC51 FOR DEMENTIA WITH COMPLICATIONS, WHICH MEANS
PROVIDERS COULD GET PAID EVEN MORE, AND THEN THERE’S HCC52
DEMENTIA WITHOUT COMPLICATIONS. STILL AN INCREASE BUT LESS.
SO I JUST THOUGHT I’D ADD THAT TO YOUR REPORT BECAUSE I THINK
THAT’S A STEP FORWARD. MY QUESTION IS, FOR THE
PARTNERSHIP, IS THERE ANY TALK ABOUT MOVING THAT TO
PRECIPITATION OF ANTIPSYCHOTICS FOR COMMUNITY DWELLING OLDER
ADULTS? I UNDERSTAND THE AMOUNT OF THAT
TYPE OF PRESCRIBING IS GOING UP.>>SO THIS IS WHERE — THIS IS
EXACTLY WHY WE INCLUDED ANTIPSYCHOTICS AND OTHER
MEDICATIONS IN THE PUBLIC USE DATASET.
SO WE STARTED, WE ARE VERY INTERESTED IN MOVING IN THAT
DIRECTION. HOWEVER, WHEN IT COMES TO
PRESCRIBING IN NON-FACILITY SETTINGS, IT’S A MATTER OF
PREFERENCE OR PRACTICE AND SO, YOU KNOW, THERE’S NO FEDERAL
AUTHORITY OVER ASSISTED LIVING FACILITIES AS AN EXAMPLE OR, YOU
KNOW, TO BE ABLE TO DICTATE TO CLINICIANS HOW THEY PRACTICE,
HOW WOULD THEY PRESCRIBE. THIS IS A MATTER OF PRACTICE
PREFERENCES. SO WE’VE BEEN VERY MINDFUL OF
THAT, AND YET MAKING THE DATA AVAILABLE, I THINK IS A
PRODUCTIVE PATH FORWARD. THE DATA BEING AVAILABLE,
CLINICIANS AND PRACTICES CAN ACTUALLY LOOK AT HOW THEY ARE
DOING AS WELL. AND WE HAVE NOT GOTTEN TO THIS
POINT, ARE THEY ABOVE A CERTAIN CUT POINT OR ARE THEY ON THE
98TH PERCENTILE OF PRESCRIBING PRACTICES?
IT’S COMPLEX, THOUGH, BECAUSE THERE MAY BE CERTAIN CLINICIAN
PRACTICES WHO THIS IS WHAT THEY DO, THEY MANAGE DEMENTIA WELL
AND MANAGE BEHAVIORAL SYMPTOMS WELL, AND SO THEY MAY BE THE
SOURCE OF CLINICAL CARE TO A VERY VULNERABLE POPULATION OF
BENEFICIARIES. SO HARD FOR CMS TO REALLY
DICTATE WHAT’S THE RIGHT NUMBER. ZERO IS NOT THE RIGHT NUMBER.
THERE’S NO RIGHT NUMBER THAT REALLY WE CAN COME FORWARD WITH.
AND ON THE POINT OF MEDICARE ADVANTAGE AND THE HCC SCORING, I
THINK THIS WOULD BE ANOTHER INDICATION, SO WE HAVE BILLING
CODES FOR COGNITIVE IMPAIRMENT EVALUATION THAT ALSO INCLUDES
CAREGIVER ASSESSMENT IN FEE FOR SERVICE, AND SO THIS WOULD BE
ANOTHER INDICATION ALTHOUGH INDIRECTLY THAT DEMENTIA CARE
DIAGNOSIS IS IMPORTANT. SO JUST WANTED TO THANK YOU FOR
ADDING THAT.>>BRAD.
>>JUST A COMMENT AND A QUESTION.
THE PROGRAM TO KEEP INDIVIDUALS AT HOME IS JUST SPECTACULAR, THE
DATA FOUR YEARS IN A ROW OF ECONOMIC GAINS IN ADDITION ARE
GREAT. I GUESS A COMMENT IS THAT TO MY
WAY OF THINKING, THE ECONOMIC GAINES ARE PART OF THE MEASURE
OF EFFECTIVENESS OF THAT BUT BY NO MEANS A BIG PART OF THE
MEASURE OF EFFECTIVENESS OF THAT, THAT THERE’S AN
ENORMOUS — I DON’T KNOW HOW TO QUANTITATE THAT, BUT ANYONE WHO
CARES FOR AN ELDERLY INDIVIDUAL, YOU KNOW, WOULD HAVE THE
INSTINCT THAT THERE’S A HUGE BENEFIT IN AS WELL.
SORT OF A RELATED QUESTION, A VERY IMPRESSIVE NUMBER IS
$40 MILLION SAVING 1400E.R. VISITS FEWER, WHATEVER, I DON’T
HAVE A SENSE OF THE DENOMINATORS THERE.
IS THAT 1400 VISITS MIGHT BE AN HOUR OF WHAT THE — I MEAN, IS
THAT A LOT, IS THAT A LITTLE? BUT THE BIG POINT IS THAT PEOPLE
ARE STAYING AT HOME.>>RIGHT.
I THINK THAT’S A REALLY IMPORTANT AND POIGNANT COMMENT.
SO COST MATTERS, RIGHT, AND IT IS ALSO AN ADMINISTRATIVELY
DEFINED DATA SOURCE. WHICH ACTUALLY FOR CMS AND
PARTICULARLY FOR THE INNOVATION CENTER MATTERS TREMENDOUSLY
BECAUSE OF ITS SPECIFIC AUTHORITY.
SO THE AUTHORITY IS TO TEST NEW CARE AND PAYMENT MODELS WHERE
QUALITY AND COST ACTUALLY ARE COMPUTED TOGETHER TO COME UP
WITH VALUE. SO WE STARTED WITH — THIS IS
SOMETHING YOU’LL SEE WITH OUR OTHER PROGRAMS AS WELL, THAT
WHICH IS UNDER OUR CONTROL WHICH IS THE ADMINISTRATIVE DATA, AND
I THINK ADMINISTRATIVE DATA IS A GOOD BLANKET WAY OF ACTUALLY
TRACKING HOW WE ARE DOING IN GENERAL.
TO YOUR QUESTION ABOUT, IS THE NUMBER OF EMERGENCY DEPARTMENT
VISITS, IS IT A LOT? IT SOUNDS LIKE A LOT.
BUT THE PRINCIPLE THERE IS WHEN YOU’RE IN A FACILITY, WHETHER
IT’S THE HOSPITAL OR AN EMERGENCY DEPARTMENT, YOU’RE NOT
AT HOME. SO THERE’S A PRINCIPLE THERE
THAT SUPPORTS WHY WE ACTUALLY ALSO LOOK AT THESE, AND WE’RE
ABLE TO ALSO LOOK AT AVOIDABLE ADMISSIONS AND READMISSIONS.
WHICH WE HAVEN’T REALLY TALKED ABOUT, BUT THEY ARE SOMETHING
LIKE ADMISSION FOR ADVERSE STROKE EVENT, WHICH PEOPLE WITH
DEMENTIA ARE AT INCREASED RISK. SO YOU WILL BE ABLE TO SEE
THREADS OF HOW — WHAT WE ARE LOOKING AT ACTUALLY ARE
APPLICABLE TO THE POPULATION OF PEOPLE WITH DEMENTIA, BUT IT
WON’T SAY SPECIFICALLY THIS IS A DEMENTIA MODEL FOR A VARIETY OF
REASONS. INCLUDING WE KNOW THAT IT’S AN
UNDERDIAGNOSIS.>>[INAUDIBLE] THE VALUE, YOU
ALLUDED TO THAT, THAT IT’S A QUALITY —
>>YES. SO THERE ARE — EACH OF THE
MODELS HAVE TO INCLUDE QUALITY, UNLESS IT WAS A PURE PAYMENT
MODEL, SO WE HAVE SIX QUALITY MEASURES THAT ARE — SO THE
DENOMINATOR IS PEOPLE THAT HAVE A DIAGNOSIS, WE ARE WORKING ON A
QUALITY MEASURE TO ENCOURAGE ASSESSMENT OF COGNITION IN
PEOPLE SUSPECTED OF HAVING COGNITIVE IMPAIRMENT.
SO IN ADDITION JUST TO CONNECT THE DOTS, I THINK THERE’S
TREMENDOUS OPPORTUNITY BEING THAT DELIRIUM IS A RISK FACTOR
AND ALSO A CONSEQUENCE, IT ACTUALLY IS A SURROGATE
INDICATOR, PERHAPS, OF BEING AT RISK OF DEMENTIA.
SOME OF THE METRICS CAN BE APPLIED TO CLINICIANS WHO ARE
PRACTICING IN FACILITIES, ALTHOUGH NOT HELD TO THE
FACILITY ITSELF, SO YOU KNOW, DETECTING COGNITIVE IMPAIRMENT,
THAT MEASURE THAT IS IN DEVELOPMENT ACTUALLY WOULD BE
APPLICABLE TO CLINICIANS WHO ARE PRACTICING IN FACILITIES LIKE
HOSPITALS. SO YOU’RE RIGHT, WE HAVE TO BE
ABLE TO MEASURE QUALITY AND COST TO COMPUTE VALUE.
MY QUESTIONS EARLIER ABOUT WHAT DOES A SIX-PACK OF MEASURES
ACTUALLY LOOK LIKE, METRICS FOR THE FUTURE STATE OF PRACTICE.
WHETHER THAT PRACTICE IS ALL OUTPATIENT OR IS ACTUALLY AN
EPISODE THAT CROSSES SETTINGS. I THINK WE HAVE OPPORTUNITY TO
ACTUALLY LOOK AT THAT AND CMS DOESN’T DEVELOP ALL OF THE
MEASURES THAT CMS IMPLEMENTS IN PROGRAMS, SO IF WE KNOW WHAT THE
CRITICAL COMPONENTS ARE OF THAT, IN A POPULATION HEALTH APPROACH,
WE CAN THEN THINK ABOUT WHAT VALUE LOOKS LIKE FOR THAT
POPULATION.>>THANK YOU FOR A VERY DETAILED
ANSWER. I’D LIKE TO RECOMMEND THAT THERE
BE A MORE IN DEPTH DISCUSSION OF MEASUREMENT IN GENERAL AND THAT
WE DIG DEEPER. I HAVE A FOLLOW-UP QUESTION THAT
WE DON’T HAVE TIME FOR AND THAT IS, YOU KNOW, DO YOU HAVE
MEASURES FOR WHAT’S DRIVING THE CHANGE IN THE NATIONAL
PARTNERSHIP AND WHAT’S NOT — WHAT’S PREVENTING CHANGE IN
TERMS OF LIKE A FORCE FIELD ANALYSIS OF WHAT KEEPS THE
BEHAVIOR IN PLACE AND WHAT ARE THE MAIN DRIVERS, BECAUSE THAT
WOULD LEAD IMMEDIATELY TO RECOMMENDATIONS TO STRENGTHEN
THE PARTICULAR FACTORS THAT ARE DRIVING THE CHANGE.
BUT I THINK THIS KIND OF CONVERSATION IS EXACTLY WHAT IS
NEEDED TO PROPEL THE MEASUREMENT FORWARD.
SO THANK YOU. TO THAT, WE’RE GOING TO MOVE ON
TO YOU, HELEN.>>I’M GOING TO GIVE THE
LONG-TERM SERVICES AND SUPPORTS UPDATES, I’LL DO ASPE, ACL AND
THEN I’LL TURN IT OVER TO LISA. SO JUST QUICKLY, ASPE HAS A
COUPLE OF NEW REPORTS ON LONG-TERM SERVICES AND SUPPORTS.
THE FIRST TWO ARE ON DUAL ELIGIBLE STATUS OF PEOPLE WHO
ARE DULY ELIGIBLE FOR MEDICARE AND MEDICAID, MANY OF WHOM HAVE
DEMENTIA. YOU WOULD THINK THAT WHEN YOU
SPIN DOWN AND MEET THE INCOME ASSET AND FUNCTIONAL ELIGIBILITY
REQUIREMENTS, THAT YOU WOULD STAY IN DUAL STATUS, THAT
THERE’S ACTUALLY QUITE A BIT OF CHURN AND THERE ARE PEOPLE WHO
CYCLE IN AND OUT OF DULY ELIGIBLE STATUS AND IMPLICATIONS
FOR CARE THAT THEY RECEIVE. SO WE HAVE TWO REPORTS ON THAT
CHURN RIGHT NOW AND SOME OF THE THINGS THAT CONTRIBUTE TO IT.
WE ALSO HAVE A PRETTY ROBUST MICRO SIMULATION MODEL ON NEED
FOR LONG-TERM CARE, COST AND CAREGIVER UTILIZATION SO WE HAVE
THREE NEW REPORTS OUT ON HOW MANY OLDER ADULTS CAN AFFORD TO
PURCHASE HOME CARE BASED ON ASSETS AND OUR MICRO SIMULATION
MODEL. THE LIFETIME RISK OF NEEDING AND
RECEIVING LONG-TERM SERVICES AND SUPPORTS, AND THE OUT OF POCKET
AFFORDABILITY OF LONG-TERM SERVICES AND SUPPORTS.
I THINK IT’S IMPORTANT TO NOTE HERE THESE ARE GENERAL NEEDS FOR
LONG-TERM SERVICES AND SUPPORTS. WE ALSO HAVE ANALYSES UNDER WAY
RIGHT NOW THAT WE HOPE TO BE ABLE TO REPORT SOON ON THE
DEMENTIA-SPECIFIC COST, UTILIZATION AND LIKELY IMPACT
OVER TIME THAT SHOULD BE SOON AND YOU WON’T BE SURPRISED TO
KNOW THAT DEMENTIA WINDS UP BEING THE TAIL OF LONG-TERM
SERVICES AND SUPPORTS IN TERMS OF TIME, SERVICES USED AND
COSTS. AND THEN FINALLY, WE HAVE A
REPORT FROM THE SUPPORT AND SERVICES AT HOME EVALUATION, THE
SASH MODEL, IN THE STATE OF VERMONT THAT MARRIES LONG-TERM
SERVICES AND SUPPORTS WITH HOUSING PROVIDERS TO PROVIDE
SERVICES TO PEOPLE WHO ARE IN HUD-SUPPORTED HOUSING, AND IT’S
BEEN VERY SUCCESSFUL AND A MODEL WE THINK CAN BE REPLICATED AND
THAT EVALUATION IS UP ON OUR WEBSITE AS WELL.
SO TURNING TO ACL’S ACCOMPLISHMENTS, THIS IS THE
SECOND ROUND OF GRANTS THEY’VE BEEN ABLE TO FUND THIS YEAR.
THERE ARE ABOUT A MILLION DOLLARS, THEY ARE JUST AT THE
BEGINNING OF DISCUSSING WHAT WORK THEY’RE GOING TO BE DOING
THROUGH THE ALZHEIMER’S DISEASE PROGRAMS INITIATIVE.
ACL IS ALSO FUNDING A THIRD ROUND OF GRANTS AND THOSE
APPLICATIONS ARE DUE AUGUST 13TH.
THEY STILL HAVE $10 MILLION, OVER $10 MILLION IN FUNDING TO
AWARD AND EXPECT TO MAKE 13 AWARDS SO IF YOU KNOW STATES OR
COMMUNITIES THAT WOULD BE ELIGIBLE OR ARE INTERESTED,
PLEASE ENCOURAGE THEM TO APPLY AND APPLICATIONS ARE DUE IN TWO
WEEKS. THE RAISE FAMILY CAREGIVERS ACT
AND THE GRANDPARENTS RAISING GRANDCHILDREN ACT, THESE ARE TWO
PIECE OF LEGISLATION THAT RECENTLY PASSED THAT ARE VERY
SIMILAR TO NAPA. THEY ESTABLISH ADVISORY COUNCILS
AND ALSO CALL FOR STRATEGIES. ACL IS EXCITED TO ANNOUNCE THAT
28 SPECIAL GOVERNMENT EMPLOYEES FOR THESE COUNCILS ARE IN
PROCESSING. THE MEETING SHOULD BE OCCURRING
IN THE PRETTY NEAR FUTURE. THEY HAVE LOGISTICS CONTRACTORS
IN PLACE AND SO LOOK FOR THE ANNOUNCEMENT OF WHEN THOSE
MEETINGS WILL BE. THE RAISE FAMILY CAREGIVERS ACT
CALLS FOR ACL TO HAVE A RESOURCE CENTER AND UNFORTUNATELY DOES
NOT HAVE AN APPROPRIATION FOR THAT RESOURCE CENTER, SO IN
PARTNERSHIP WITH THE HART FOR FOUNDATION WHO OFFERED UP THE
FUNDING FOR THE RESOURCE CENTER, NATIONAL ACADEMY FOR STATE
HEALTH POLICY IS GOING TO BE CARRYING OUT THAT WORK OVER THE
NEXT TWO YEARS. ACL HAS TWO UPCOMING WEBINARS
THROUGH THEIR NATIONAL ALZHEIMER’S DISEASE RESOURCE
CENTERS. , FOR PEOPLE LIVING WITH
DEMENTIA, THAT ONE WILL BE NEXT TUESDAY, AUGUST 6TH.
, AND ANOTHER PRESENTATION IN SEPTEMBER ON STRATEGIES FOR
SUSTAINING THE GRANT PROJECT SO I THINK THIS IS A REALLY
IMPORTANT ONE BECAUSE IT’S NOT JUST ABOUT WHAT ACL CAN FUND.
IT’S ABOUT HOW THE GRANTEES ARE USING THE FUNDING TO LEVERAGE
OTHER SOURCES AND BUILD THE INFRASTRUCTURE TO CONTINUE TO
PROVIDE THESE SERVICES OVER TIME AND IT ALSO TIES INTO OUR
MEASUREMENT WORK BECAUSE IT’S NOT JUST WHAT THEY’RE FUNDED TO
DO, IT’S A LONGER TERM IMPACT. IN ADDITION OVER THE LAST TWO
MONTHS, ACL HAS HAD FIVE WEBINARS IN THE ALZHEIMER’S
DISEASE AND RELATED DEMENTIA SPACE.
I WON’T GO THROUGH ALL OF THEM BUT THEY ARE AVAILABLE ON THE
NADRC WEBSITE. THE NATIONAL ALZHEIMER’S CALL
CENTER, A PARTNERSHIP BETWEEN ALZHEIMER’S ASSOCIATION AND ACL,
ALSO HAD TWO RECENT WEBINARS IN APRIL AND IN MAY THAT ARE ONLINE
THAT WE CAN LOOK AT. CONNECTING PEOPLE TO THE HELP
THEY NEED AND ALZHEIMER’S AND BRAIN HEALTH, WHAT YOU NEED TO
KNOW. THESE ARE SOME OF THE MATERIALS
THAT WILL BE COMING OUT OVER THE NEXT FEW MONTHS.
IGG AND DEMENTIA PRACTICAL STRATEGIES GUIDE, HIGHLIGHTS OF
THE ACL ALZHEIMER’S AND DEMENTIA PROGRAM GRANTEES DEVELOPED
RESOURCES SO WHAT THEY’VE BEEN ABLE TO DO AND WHAT’S WORKED
BEST IN THE GRANTEES. DEMENTIA CAPABLE STATES AND
COMMUNITIES, THE BASICS, THIS IS AN UPDATE FROM A PREVIOUS 2014
PRACTICAL GUIDE FOR MAKING YOUR COMMUNITY OR STATE DEMENTIA
CAPABLE. AND THEN FINALLY, AN UPDATE
BASED ON INTERVENTIONS THAT THE GRANTEES HAVE DONE ON EVIDENCE
BASED AND EVIDENCE INFORMED INTERVENTIONS.
THEN FINALLY THE NATIONAL INSTITUTE ON DISABILITY IND PENT
LIVING AND REHABILITATION RESEARCH HAS A NEW FUNDING
ANNOUNCEMENT FOR ADVANCING COGNITIVE TECHNOLOGIES.
ALTHOUGH NIDILRR DOES A LOT OF WORK IN THE YOUNGER DISABILITY
SPACE, IN THE PAST YEAR, THIS CENTER FUNDED A STUDY ON THE
QUALITATIVE EFFECTIVE IDENTITIES — A QUALITATIVE
STUDY OF EFFECTIVE IDENTITIES IN DEMENTIA PATIENTS FOR THE DESIGN
OF COGNITIVE ASSISTIVE TECHNOLOGIES.
SO THIS MIGHT NOT BE A PLACE OUR GRANTEES USUALLY LOOK BUT IT’S
ANOTHER OPPORTUNITY TO LOOK AT TECHNOLOGY RELATED TO COGNITION
AND OF FUNDING OPPORTUNITY. I’LL TOSS IT OVER TO LISA.
ANY QUESTIONS ALTHOUGH I PROBABLY CAN’T ANSWER THEM?
ALL RIGHT. WELL, THANK YOU VERY MUCH.
SO A FEW OF THE NEW THINGS>>A FEW OF THE NEW THINGS WE
HAVE AT CDC IS A HEALTHY AGING PORTAL ON OUR WEBSITE.
I’M EXCITED TO ANNOUNCE WE JUST FINISHED OUR 2019 UPDATE OF THE
DATA AND THAT INCLUDES DATA FOR OLDER AMERICANS FROM THE
BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, WHICH IS
THE WORLD’S LARGEST CONTINUOUSLY OPERATING TELEPHONE SURVEY, YES,
I SAID TELEPHONE, THEY DO DO TELEPHONE SURVEYS, AND IT IS
ABOUT 450,000 PEOPLE ANNUALLY IN THE U.S.
SO THAT IS THE 2017 DATA UPLOADED INTO THE PORTAL.
SOME OF THE COOL THINGS ABOUT THAT DATA PORTAL IS THIS IS WHAT
THE WEBSITE LOOKS LIKE, AND YOU CAN SEE THERE’S A COUPLE
DIFFERENT OPTIONS, AND OPPORTUNITIES ONCE YOU’RE THERE,
SO YOU CAN GO THROUGH AND SELECT A SINGLE VARIABLE AND LOOK AT
THAT VARIABLE FOR THE WHOLE NATION SO THIS IS SEPARATED FOR
ADULTS 50 TO 54 YEARS OLD SO YOU CAN SELECT AND PICK WHICH
GRAPHIC YOU WANT TO CREATE, AND YOU ALSO CAN CREATE INFO
GRAPHICS FROM VARIOUS DATA THAT YOU ARE SELECTING.
SO YOU CAN DO THIS OVERALL FOR THE NATION OR YOU CAN SELECT A
SPECIFIC STATE THAT YOU WANT TO LOOK AT THAT VARIABLE ON
GRAPHICALLY. SO I’VE TALKED A LITTLE ABOUT
THE INFO GRAPHICS TO YOU ALL MANY TIMES, BUT THE THING I WANT
TO POINT OUT TODAY IS THAT WE ARE, WORKING ON FINALIZING THE
SPANISH TRANSLATION, SO WE ARE AT THE FINAL PROOFING STAGE SO
IF YOU NOTICE ANYTHING, PLEASE LET LEE KNOW BEFORE WE PRINT
THOUSANDS OF THEM. NOT REALLY THOUSANDS.
IT WILL FEEL LIKE IF WE’D HAVE TO GET RID OF EVEN FIVE OF THEM.
SO WE HAVE A SIMILAR INFOGRAPHIC FOR OUR CARE MODELING AS WELL,
ALSO FOR OUR RATES AND ETHNICITY PORTFOLIO FOR THE INFO GRAPHICS
FOR HISPANIC ADULTS, WE’RE ALSO TRANSLATING THOSE INTO SPANISH
FOR SUBJECTIVE COGNITIVE DECLINE AND ALSO FOR CAREGIVING.
WE’VE HAD A LOT OF CONVERSATION TODAY ABOUT CARDIOVASCULAR
DISEASE AND CARDIOVASCULAR RISK FACTORS, SO I’M REALLY PROUD TO
ANNOUNCE THAT OUR THIRD DATA BRIEF IN THE SERIES IS ON
CARDIOVASCULAR DISEASE. YOU CAN SEE THE FIRST AND THE
SECOND ON THE OUTSIDE. THERE WILL BE TWO MORE OF THESE
TO COME THAT I WILL SHARE WITH YOU IN THE NEXT FEW MONTHS, AND
THAT WAS DEVELOPED IN COLLABORATION WITH OUR CDC
COLLEAGUES IN THE DIVISION OF HEART DISEASE AND STROKE
PREVENTION, AS WELL AS OUR PARTNERS AT THE NATIONAL
ASSOCIATION OF CHRONIC DISEASE DIRECTORS.
THROUGH OUR AGING AND HEALTH WORK GROUP AT CDC, WE HAVE
LAUNCHED A PODCAST SERIES. THERE ARE TWO PODCASTS THAT ARE
MOST RELEVANT TO THIS GROUP. BOTH OF THESE WERE DONE BY
DR. CHRISTOPHER TAYLOR, WHO’S PART OF CDC’S ALZHEIMER’S
DISEASE AND HEALTHY AGING PROGRAM.
THE FIRST ONE IS TALKING ABOUT MEMORY LOSS IS NOT A NORMAL PART
OF AGING WHICH I THINK WE’VE HEARD THAT A COUPLE TIMES TODAY
AND ALSO ON DR. TAYLOR’S PUBLICATION ON ALZHEIMER’S
DISEASE DEATH. AND THERE WILL BE MORE OF THESE
PODCASTS FORTHCOMING RELATED TO ALZHEIMER’S DISEASE AND RELATED
DEMENTIAS, BUT I ENCOURAGE YOU TO CHECK THEM OUT BECAUSE THERE
ARE A VARIETY OF AGING-RELATED ISSUES.
I SHOWED YOU ONE OF THESE EARLY YES ABOUT ONE OF OUR WEB
FEATURES. WE DID A WEB FEATURE IN MAY AND
ANOTHER ONE IN JUNE. SO ONE OF THEM IS ABOUT THE
TRUTH ABOUT AGING AND DEMENTIA, SO ONCE AGAIN, THAT MESSAGE THAT
WE’RE TRYING TO MESSAGE IS THAT DEMENTIA IS NOT A NORMAL PART OF
AGING AND WE HAD A SERIES OF STATISTICS THAT WENT ON IN THE
DID YOU KNOW AND I SHOWED THIS IN MY PREVIOUS PRESENTATION.
SO IF YOU HAVEN’T SIGNED UP FOR THE NEWSLETTER WHILE YOU’RE
SITTING OUT THERE, PLEASE DO, GO VISIT OUR WEBSITE AND THANK YOU
VERY MUCH.>>QUESTIONS?
WE’RE HUNGRY. THANK YOU FOR EXCELLENT UPDATES
AND GREAT PROGRESS. SO WE’RE GOING TO GO TO LUNCH
NOW, AND WE WILL START AGAIN PROMPTLY AT 1:30.
OKAY? THANK YOU.

Stephen Childs

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