2013 Implementation Actions by HHS Agencies

Office of the Assistant Secretary for Health (OASH)

• Collaborated with HRSA to develop, award, and implement an evaluation project on interprofessional health care workforce education and training to improve the health of persons with MCC.
• Led collaboration with professional organizations that develop clinical practice guidelines to better inform guidelines on relevant comorbidities, including, for example, the American College of Cardiology Foundation / American Heart Association updated clinical guideline on heart failure treatment which incorporates data on comorbidities to heart failure as provided by CMS.

Administration on Community Living (ACL)

• Provided 22 grants to deliver evidence-based self-management programs that serve individuals with MCC (to date, over 194,000 individuals have participated in the Chronic Disease Self-Management Program).
• Engaged in innovative approaches with foundations to build the business capacity of the aging and disability networks to contract with health care entities and receive reimbursement to sustain these evidence-based programs and other quality services.

Agency for Healthcare Research and Quality (AHRQ)

• Fostered clinical, community, and patient-centered research by issuing two funding announcements to generate evidence to optimize processes, care, treatments and health of MCC patients, and to test and validate new methods involving research on patients with MCC.

Assistant Secretary for Planning and Evaluation (ASPE)

• Advanced research on disparities in MCC populations by sponsoring development of a report on data systems and data sets that can be analyzed to better improve understanding of and approaches to addressing disparities in MCC populations.

Centers for Disease Control and Prevention (CDC) 

Coordinated agencies’ (AHRQ, CDC, CMS) collaboration in completing and releasing a set of federal data reports in Preventing Chronic Disease on MCC prevalence, health-care utilization, and costs. 

Centers for Medicare and Medicaid Services (CMS)

• Issued rule in the Medicare 2014 Physician Fee Schedule for Chronic Care Management services for individuals with MCC.
• Continued implementation of several Affordable Care Act provisions testing care models for populations with MCC.
• Developed and released public-use data resources on MCC prevalence, healthcare utilization, and costs among Medicare beneficiaries at the state, county, and hospital referral region levels, and an interactive data dashboard allowing for examination of state- and hospital referral region-level MCC patterns among Medicare beneficiaries.
• Integrated into the CMS Quality Strategy specific goals, objectives and measures targeting care for populations with MCC. 

Food and Drug Administration (FDA)

• Finalized efforts to increase the external validity of relevant clinical trials by assessing the inclusion of individuals with MCC and by reducing the unnecessary exclusion of such individuals from clinical trials.

Health Resources and Services Administration (HRSA)

• Awarded 27 new advanced nursing education grants to integrate the care of individuals with MCC into interprofessional education for advanced nursing education students.
• Provided 133 continuation grants to sustain education of health professions students, faculty, practitioners, direct services workers, and lay and family caregivers on the care of individuals with MCC. 

Indian Health Service (IHS)

• Added further capacity to its ONC-certified Electronic Health Record to support management of the complex care of patients with MCC, including the foundation for an integrated problem list and the enhanced inter-operability that will allow electronic sharing of data for care coordination.
• Through its Improving Patient Care program, engaged an additional 30 sites in developing medical homes more capable of providing care for persons with MCC, bringing to a total of 125 IHS and Tribal sites that are engaged in developing medical homes.

National Institutes of Health (NIH)

• Published MCC-focused funding opportunities to: 1) increase clinical, community, and patient-centered research supported by NIH, including more effective research methods and measures for conceptualizing, triaging, and assessing the health
• behavior of patients with MCC;  2) foster the development of a common conceptual model to develop behavioral interventions to improve health outcomes in patients with MCC; and 3) enable demonstration projects across healthcare systems for efficient, large-scale pragmatic clinical trials focused on management of patients with MCC.
• Awarded three infrastructure building grants to enable testing of innovative services delivery approaches that are aimed at reducing medical comorbidities related to shortened lifespan in people with serious mental illnesses.
• Initiated examination of a sample of late-stage clinical trials with a focus on whether the inclusion/exclusion criteria could unnecessarily preclude enrollment of subjects with MCC. 

Substance Abuse and Mental Health Services Administration (SAMHSA)

• Administered an extensive demonstration portfolio on Primary and Behavioral Health Care Integration (100 grants) to learn how best to improve the physical health status of people with serious mental illness and co-occurring addictions by coordinating and integrating primary care services into publicly funded, community-based behavioral health settings.