About the NCCC

July 7, 2003

Dear NCCC Members and Friends:

This is to inform you that the NCCC Board has voted to begin the process of termination of NCCC business operations effective July 1, 2003. Plans are being made to continue work of the Medicare Payment Coalition and the Alzheimer's demonstration through the end of the year, within the limits of available resources, with future work contingent upon decisions of those involved. All other NCCC activity is being terminated as soon as possible.

This announcement is made with sadness and regret, as the work of the NCCC has been an important source of leadership and support for many people. However, there comes a time in any organization when leadership must declare the organization's work complete and find new ways of pursuing related business interests.

Since 1991, the NCCC has been an important resource in bringing national prominence to chronic care reform. It has helped create a national sense of urgency, understanding, and commitment for new and improved policies, structures, and clinical methods for serving people with multiple, complex chronic conditions. It has successfully developed new tools and methods for enabling leading primary, acute and long-term care providers to establish new business methods for people with chronic conditions. It has been successful in its efforts to educate national policy leaders on legislative and regulatory impediments and options for improving quality and cost outcomes for people with multiple, complex care needs, resulting in important national and state legislation and demonstrations. We are particularly proud and pleased with the level of progress that has been made in Congress and in CMS on improving payment methods for physicians serving people with multiple, complex care needs; on establishing risk adjustment methods and specialty M+C provisions; and for establishing an IoM study on barriers to smooth transitions and care continuity.

Unfortunately, while health leaders across the spectrum of payer, provider, policy, research, and consumer organizations express interest and support for the NCCC's mission and work; there does not appear to be sufficient resources available to successfully continue business operations. We will be in touch with members and others with information on help that will be needed for termination.

In the interim, we want to thank you for your involvement and support. The NCCC has been a truly remarkable effort of diverse and talented leadership. If you would like further information on this decision, please call either of us at 212-337-5760 for Arthur or at 202-624-1516 for Rich.

Sincerely,

Arthur Y. Webb
Board Chair

Richard J. Bringewatt
President and CEO

July 7, 2003

Dear NCCC Members and Friends,

In another letter Arthur Webb and I informed you of the NCCC Board's decision to terminate NCCC operations as soon as possible. This letter is to inform you of my personal support for that decision and to let you know that I am extremely grateful for your long-standing commitment to the cause of chronic care reform.

We have come a long way since our inception in January of 1991. I use the word "we" very intentionally, as none of our work has ever been the work of any one person. It was always "the we thing" that gave us our greatest power.

We were always more about the crossroads of care than about the tasks of individual professionals, programs, or organizations. We talked about person-centered care and being consumer-driven, but our primary interest was always in doing whatever we could (in the collective) to prevent, delay, or minimize chronic disease and disability progression. We were mission-driven but actionoriented. As a result, we evolved FROM a national collaborative of 14 leading health care systems, who came together to share information and material to improve care for people with chronic conditions TO a national alliance of innovative health leaders, known and respected among purchasers, payers, providers, policymakers, researchers, and consumer organizations nationwide.

We have produced a number of important tools, materials, demonstrations and care methods along the way. Of particular note are the chronic care network model that served as the foundation for our initial NCCC dialog, SASI, the CCN/AD project, CareLink, our experience-based, changeoriented Web site, material produced in support of the Minnesota Senior Health Options Program (M/SHO) and other dually eligible programs. We have also produced important leadership positions through multiple scientific and professional trade journal publications and NCCC produced tool boxes, issues briefs and case studies on risk screening, extended care pathways, integrated financing, and transforming care for those dually eligible for Medicare and Medicaid.

Some people talk fondly of the NCCC working sessions, board retreats, and other shared learning experiences that seemed to fuel the creativity and energy of champions seeking ways to break through the silos of our current delivery system. "Shared learning" became almost a mantra for the NCCC. We need "a little less talk and a lot more action" was a shortened way of saying that thinking and doing are part of the same change process. The PBS Fred Friendly Seminar on chronic illness care, the Medicare Payment Coalition, our regulatory reform initiative, the national chronic care policy coalition, introduction of the Chronic Care Act, restructuring our board, and a variety of national partnerships with key national associations and corporations were all ways that the NCCC reached out to others who shared our vision and values in seeking to produce new methods of care for people with chronic conditions, under mainstream market conditions.

Much of our language and ideas are pretty common place these days. The Institute of Medicine, the National Academy of Social Insurance and the Progressive Policy Institute, among others, have identified chronic care reform as among the most important priorities for health care reform. Many of their recommendations for change are consistent with long standing positions of the National Chronic Care Consortium. Also, this year, a version of the Chronic Care Act was introduced for the third year in a row.

I am particularly pleased with early signs that a few national leaders are starting to pick up on the fact that people with multiple, complex chronic conditions have special and unique care needs. These needs defy the logic of current financing, administration and delivery methods. Last week, in speeches on the Senate floor, Senators Lincoln and Smith both referenced that 20 percent of Medicare beneficiaries have five or more chronic conditions and account for 66 percent of Medicare costs. They talked eloquently about the importance of establishing new methods of care for this population, the Consortium's core interest.

Most importantly, both the Senate and the House passed amendments to establish specialty M+C plans as a unique designation within the overall Medicare program. Statutorily defined "specialty M+C plans" as a concept, emanated from our Medicare Payment Coalition, a group of managed care plans, demonstrations and programs with special skills in serving people with multiple, complex care needs. Also, the Senate version of the Medicare drug bill contains an allocation of six billion dollars for chronic care programs, including a demonstration initiative, crafted in large part through assistance of the NCCC, to provide a monthly fee for physicians serving people with multiple, complex care needs. And, the House Medicare bill contains provisions for an IoM study of barriers for transitions and care continuity, also an NCCC lead initiative.

Finally, I am very pleased to say that CMS has become a strong advocate of risk adjustment, particularly in serving high-risk populations, as well as for building upon the specialty M+C provisions recently passed by both Houses of Congress. The establishment of a "frailty adjuster", as a complementary standard M+C risk adjustment system, is an important outgrowth of MPC advocacy efforts.

It is clear that the NCCC has been an important force in helping bring chronic care reform to the point where it is today. All of you should feel proud of a job well done, with important changes being made under very adverse market conditions. The next step of reform is yet to be defined; although it is likely to come from a number of different sources.

As chronic care reform grows in prominence, I am particularly concerned that the powers of selfinterest may or may not produce good public policy. I am concerned that year after year health policy decisions are driven increasingly by budget policy and interest group politics, and less and less by the need of our most vulnerable population. I am concerned about the narrow application of evidence-based guidelines that may or my not apply to care of people with complex care needs. I am concerned about the tendency of academic-based health centers to isolate their efforts to research publication, and to ignore the realities of what it takes to transform culture and to actually produce good public policy.

Under any circumstances, to be successful in our mission to improve care for people with multiple, complex care needs, those within the NCCC and others who share our values must: (1) find new and improved ways of empowering consumers; (2) merge the powers of new technology with the intellectual capital of complex, chronic care management; (3) change financial structures and incentives for plans and providers to craft new methods for serving those in greatest need; and (4) establish new integrated, clinically-based methods of caring for people with multiple, complex, and ongoing care needs.

As we celebrate (or morn) closure of the NCCC, it is important for us to learn from our past...from our successes and failuresÉbut move on to creating new adventures. It is important for us to find new and different ways of forging change within the context of the environment in which we live today, and within the context of an environment that we must form in order to adequately address emerging changes in our health care populations.

It is important for us to remember that organizations are little more than structures and procedures to carry out the collective will of a group of people. It is important to remember that it is in the power of "new" ideas, of relationships, and of a common commitment to a cause that is greater than one's self where we find the fuel needed for creating new organizations, new programs, and new life.

We never know where life may lead us. At this point in time, I quite frankly have no idea what comes next for me. But, in the midst of this life/organizational transition, it is important for all of us to adventure boldly into the unknown. It is important to try new things and learn from the experiences yet to come.

I have often said that I have never experienced as many bright, talented, creative, committed, nice people as those I have met over my years with the NCCC. This has been true with all segments of the Consortium, including staff, consultants, board, members and affiliates. I look forward to seeing you and working with you again somewhere in the future. And, as Garrison Keillor often says, "be well, do good, and stay in touch." Keep the faith in chronic care reform and be diligent in your efforts. There still is a lot of work to be done.

Sincerely,

Richard J. Bringewatt
President and CEO