In The News

New Analysis: Uninsured rate for Americans with pre-existing conditions dropped sharply when major Affordable Care Act reforms were first implemented

Without ACA protections, more than half of non-elderly Americans could face discrimination in health care

Since the Affordable Care Act (ACA) became law, millions of Americans no longer face coverage denials, higher costs, or coverage carve outs because of their medical histories. A new analysis from the U.S. Department of Health and Human Services provides a first look at what happened to uninsured rates for Americans with pre-existing health conditions when the ACA's major insurance market reforms took effect in 2014. It finds that, between 2010 and 2014, the share of Americans with pre-existing conditions who went without health insurance all year fell by 22 percent, meaning 3.6 million fewer people with pre-existing conditions went uninsured.

While data for individuals with pre-existing conditions are available only through 2014, the uninsured rate for all Americans has fallen by an additional 22 percent through mid-2016, and Americans with pre-existing conditions have likely seen similar additional gains.

"Today, thanks to Affordable Care Act protections, the uninsured rate is at its lowest level in history and millions of Americans with pre-existing conditions like asthma or cancer no longer have to worry about being denied coverage because of their medical history," said HHS Secretary Sylvia M. Burwell. "This is clear and measurable progress, and we shouldn't turn the clock back to a time when people were denied coverage."

The new analysis estimates that 51 percent of non-elderly Americans, or 133 million people, have a pre-existing health condition under the definition insurers used for underwriting purposes before the ACA. Among the most common pre-existing conditions are: high blood pressure (46 million people); behavioral health disorders (45 million people); asthma or chronic lung disease (34 million people); heart conditions or heart disease (16 million people); diabetes (13 million people); and cancer (11 million people). Because the likelihood of having a pre-existing condition increases with age, the ACA's protections are especially important to middle-aged and older Americans. Up to 84 percent of Americans between age 55 and 64, and up to 75 percent of Americans between age 45 and 54 have a pre-existing condition that could have been the basis for insurer discrimination prior to 2014.

Today's analysis confirms that the ACA's insurance market reforms are having a major impact on coverage for Americans with pre-existing conditions. After passage of the Affordable Care Act, uninsured rates declined by almost 20 percent or more among non-elderly Americans with high blood pressure, behavioral health disorders, asthma or chronic lung disease, and osteoarthritis.

The analysis also sheds light on proposals that would restrict pre-existing condition protections to people who meet standards for continuous coverage, rather than protecting anyone who signs up during an annual open enrollment period. The analysis finds that tens of millions of people with pre-existing conditions go uninsured for at least short spells due to job changes, other life transitions, or periods of financial difficulty. In the two-year period beginning in 2013, almost one third of people (44 million) with pre-existing conditions went uninsured for at least one month.

The Affordable Care Act achieved dramatic improvements in coverage for people with pre-existing conditions through three fundamental reforms: first, requiring insurance companies to cover people with pre-existing conditions; second, providing financial assistance linked to premiums and income to help make coverage more affordable; and third, by requiring all Americans to get coverage if they can afford it. Prior to the Affordable Care Act, states that tried to protect people with pre-existing conditions without other measures such as financial assistance and an individual responsibility requirement saw premiums skyrocket as not enough healthy people entered the risk pool. Under the Affordable Care Act, the number of people in the individual market has grown, and most HealthCare.gov enrollees can select a plan for less than $75 per month in premiums.

To read today's report, visit: https://aspe.hhs.gov/pdf-report/health-insurance-coverage-americans-pre-existing-conditions-impact-affordable-care-act

Transforming Health Care Delivery through the CMS Innovation Center: Better Care, Healthier People, and Smarter Spending

We have made great progress in recent years on reforming our system into one that delivers better quality of care for patients and pays for care in a smarter way, including investing more in prevention and primary care.

Before 2010, there had been only modest efforts to improve care and reduce costs. Medicare – the country's largest health care insurance program – was largely paying for health services based on volume – where providers were paid for every service they ordered or performed – which didn't necessarily improve the health of beneficiaries or preserve the program for future generations. To improve our health care system, the largest payer of health care stepped up to partner with providers, doctors and other clinicians, states, private payers, consumers, and others to spur innovation. The market and people in communities across the nation have responded this initiative in extraordinary ways and delivered better care to patients.

This has been the mission of the Center for Medicare and Medicaid Innovation (CMS Innovation Center), to align incentives, partner with others to improve the health system, and implement best practices for coordinating patient care. Since opening its doors in late 2010, the CMS Innovation Center has worked tirelessly to enhance the quality of health care delivered while not increasing costs for Medicare, Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries. The CMS Innovation Center takes locally-driven approaches – approaches from doctors and other health care partners providing care to patients every day – and gives them the platform to be tested through a collaborative process.

Today, based on the successful work of the CMS Innovation Center and countless public and private sector partners, we can now say that health care delivery system reform addressing both quality and cost has become part of the fabric of Medicare, Medicaid, and the health care sector nationwide. According to a new report to Congress prepared by the CMS Innovation Center:

  • Over 30 new payment models have been launched over the past six years.
  • Investments in electronic medical records and a data and analytics infrastructure are sparking a new set of innovative companies.
  • The CMS Innovation Center's portfolio of models has attracted participation from a broad array of health care providers, states, payers, and other partners. An estimated 18 million individuals, including CMS beneficiaries and individuals with private insurance included in multi-payer models, have been impacted by, have received care, or will soon be receiving care furnished by more than 207,000 health care providers participating in CMS Innovation Center payment and service delivery models and initiatives. These models are delivering care to people in every state across the nation.
  • Medicare exceeded – earlier than predicted – the goal to tie more than 30 percent of fee-for-service payments by the end of 2016 through alternative payment models to quality and cost metrics. Medicare is on pace to reach 50 percent by the end of 2018.

The Innovation Center has partnered with Medicare, Medicaid, and private health plans in the commercial market on new models of care and innovation. And, a number of exciting initiatives will be coming to more beneficiaries over the next few years:

  • The Medicare Diabetes Prevention Program expanded model, set to begin in 2018, will pay for services to prevent the onset of diabetes to all eligible Medicare beneficiaries, improving their health and that of the Medicare program both now and in the future. This is important because we estimate that Medicare spent $42 billion in 2016 on fee-for-service, non-dual eligible, over age 65 beneficiaries with diabetes.
  • Three new payment models—the Acute Myocardial Infarction Model, the Coronary Artery Bypass Graft Model, and the Cardiac Rehabilitation Incentive Payment Model—will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation.
  • Through the Comprehensive Primary Care Plus Model, primary care doctors can care for their patients the way they think will deliver the best outcomes, and they'll get paid for achieving results and improving care.
  • One new payment model—the Surgical Hip and Femur Fracture Treatment Model—will support clinicians in providing care to patients who undergo surgery after a hip or femur fracture beyond hip replacement. In addition, we finalized updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016.
  • The Accountable Health Communities Model, beginning in 2017, will test whether increased awareness of and access to services addressing health-related social needs will impact total health care costs and improve health and quality of care for Medicare and Medicaid beneficiaries in selected communities. This model will address a critical gap between clinical care and community services in the current delivery system.
  • Thirty-eight states and territories are engaged in the State Innovation Models initiative where they are testing their own best ideas to improve health, quality of care, and lower costs. Additionally, Vermont and Maryland have entered into global payment arrangements to improve care for the whole state's population.
  • And, already, investments in patient safety from the CMS Innovation Center, including through the Partnership for Patients, have contributed to an estimated 125,000 lives saved, over 3 million infections and adverse events avoided, and $28 billion in savings. We expect to see these numbers and savings continue to grow in the coming years.

These exciting approaches are the result of careful design, thorough and rigorous evaluation, and close collaboration with patients, doctors, and other stakeholders to achieve real, measurable, and significant results in improving health and lowering spending. CMS conducts an independent evaluation of every CMS Innovation Center model and releases those findings publicly. These reports provide stakeholders with information on the impact of the model as a whole on health care expenditures and utilization, beneficiary and health care provider experiences with care, and, where feasible, health outcomes. The reports also often provide site-specific results.

Using the CMS Innovation Center to advance better, smarter health care has become even more important over time. Since the passage of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the CMS Innovation Center has been instrumental to its implementation. The Quality Payment Program, which implements provisions of MACRA, includes a five percent incentive payment for physicians and other clinicians sufficiently participating in Advanced Alternative Payment Models. The CMS Innovation Center is the mechanism to create new Advanced Alternative Payment Models in the future. In fact, the CMS Innovation Center has recently announced more than five new or re-opened opportunities for clinicians to join Advanced Alternative Payment Models. CMS expects 125,000 to 250,000 clinicians to be participating in Advanced Alternative Payment Models by 2018. The CMS Innovation Center looks forward to partnering with doctors, clinicians, patients, and others on new models.

The CMS Innovation Center continues to work on behalf of current and future Medicare, Medicaid, and CHIP beneficiaries. After more than six years, the health care system is objectively safer while making Medicare more financially secure for future generations. Such significant progress is possible because we have worked with Congress and stakeholders to listen, adapt, and advance proven ideas. Our work in developing and expanding new payment models will continue to be guided by the following core principles:

  • Supporting innovative payment and service delivery models with strong potential to improve health care quality and lower costs.
  • Engaging with and listening to consumers, providers, and other stakeholders allowing for open and transparent dialogue, including through the appropriate use of notice-and-comment rulemaking and ombudsmen.
  • Evaluating results based on appropriately scoped and sized demonstrations and advancing best practices based on their impact on quality and cost.

Together we can continue to strive to achieve better care, healthier people, and smarter spending.

To read more detail of the accomplishments of the CMS Innovation Center, read the most recent biennial report to Congress on the Innovation Center website: https://innovation.cms.gov/Files/reports/rtc-2016.pdf

Third CMS Innovation Center Report to Congress Posted

The CMS Innovation Center has released its third Report to Congress, as mandated by section 1115A(g) of the Social Security Act. It focuses on activities between October 1, 2014 and September 30, 2016, but also highlights a number of important activities started during that time period that were announced between September 30, 2016 and December 31, 2016. The CMS Innovation Center’s portfolio of models and initiatives has attracted participation from health care providers, states, payers, and other stakeholders in all 50 states, the District of Columbia, and Puerto Rico. During this period, the CMS Innovation Center has tested or announced 39 payment and service delivery models and initiatives authorized under section 1115A authority. To improve care and value, these model tests focus on reducing program expenditures while improving the quality of care.

For additional information on the portfolio of models being tested through the CMS Innovation Center, visit the CMS Innovation website.

Medicare-Medicaid ACO Model joins growing number of state-based efforts to improve quality of care, lower costs

Today, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare-Medicaid Accountable Care Organization (ACO) Model, a new initiative designed to improve the quality of care and lower costs for beneficiaries who are enrolled in both Medicare and Medicaid.

The Medicare-Medicaid ACO Model builds on the current Medicare Shared Savings Program and advances efforts to partner with states in transforming the health care delivery system.

“This model aims to provide improved care coordination for those enrolled in both Medicare and Medicaid, allowing providers to focus more on providing care for their patients rather than administrative work,” said Dr. Patrick Conway, CMS acting principal deputy administrator. “CMS continues to partner with and leverage the best ideas from states to transform our health care system to improve quality and care coordination. In the long run, this partnership will result in healthier people and smarter spending.”

In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. However, Medicare ACOs often do not have financial accountability for the Medicaid expenditures for those beneficiaries. The Medicare-Medicaid ACO Model will allow Medicare Shared Savings Program ACOs to take on accountability for the quality of care and both Medicare and Medicaid costs for Medicare-Medicaid enrollees.

CMS is accepting letters of intent from states that wish to work with CMS to design certain state-specific elements of the model. The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicare and Medicaid. CMS will enter into participation agreements with up to six states with preference given to states with low Medicare ACO saturation. Once a state is approved to participate in the model, a request for application will be released to ACOs and health care providers in that state.

The Medicare Shared Savings Program and other ACO initiatives were created to change the incentives for how medical care is delivered and paid for in the United States, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes. ACOs are groups of doctors, hospitals, and other health care providers who voluntarily come together to develop and execute a plan for a patient’s care and share information, putting the patient at the center of the health care delivery system.

The Affordable Care Act, through the creation of the Center for Medicare and Medicaid Innovation, allows for the testing of innovative payment and service delivery models, such as the Medicare-Medicaid ACO Model. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality.

In March 2016, the Administration announced that it met the ambitious goal – eleven months ahead of schedule – of tying an estimated 30 percent of Medicare payments to quality and value through alternative payment models by 2016. The Administration’s next goal is tying 50 percent of Medicare payments to alternative payment models by 2018. The Health Care Payment Learning and Action Network established in 2015 continues to align efforts between government, private sector payers, employers, providers, and consumers to broadly scale these efforts to achieve better care, smarter spending, and healthier people.

Today’s announcement is one in a series of Innovation Center initiatives that will expand opportunities for clinicians to participate in Advanced Alternative Payment Models under MACRA. Our work in developing and expanding new payment models will continue to be guided by the following core principles:

  • Supporting innovative payment and service delivery models with strong potential to improve health care quality and lower costs.
  • Engaging with and listening to consumers, providers, and other stakeholders allowing for open and transparent dialogue, including through the appropriate use of notice-and-comment rulemaking and ombudsmen.
  • Evaluating results based on appropriately scoped and sized demonstrations and advancing best practices based on their impact on quality and cost.

We look forward to continuing to work with our many stakeholders to achieve better care for patients, better health for our communities, and lower costs through improvement for our health care system.

For more information on the Medicare-Medicaid ACO Model, including a fact sheet, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-12-15-2.html

2016 Report to Congress

The U.S. Preventive Services Task Force (USPSTF or Task Force) has released its “Sixth Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services.”

In 2016, the USPSTF continued to fulfill its mission of improving the health of all Americans by making evidence-based recommendations about clinical preventive services such as screening tests, counseling about healthy behaviors, and preventive medications. These recommendations help clinicians and their patients make informed health care decisions.

In this annual report, the USPSTF identified six recent topics for which the current evidence was insufficient for the Task Force to make a recommendation, including autism screening and tobacco smoking cessation with electronic nicotine delivery systems. The USPSTF also identified evidence gaps that prevent it from making recommendations for specific populations or age groups, such as screening for breast cancer in African American women. Future research in these areas can help fill these gaps and would likely result in important new recommendations that will help to improve the health of Americans.

Please click here to read the complete USPSTF report.

CMS releases its Person and Family Engagement Strategy

At the Centers for Medicare & Medicaid Services (CMS), we are working with numerous partners to transform our health care delivery system to one that delivers better health outcomes while spending dollars more wisely. In November of 2015, we updated the CMS Quality Strategy, incorporating the ongoing work to shift Medicare from paying for the number of services provided to paying for better outcomes for patients. We know that a key strategy to achieving better outcomes is to meaningfully engage patients as partners in decisions about their health care. Therefore, one of the six goals outlined in this strategy is: Strengthen person and family engagement as partners in care. Today, we are excited to announce the release of the CMS Person and Family Engagement Strategy, which we believe can lead to significant progress toward this important goal.

What does person and family engagement mean? We view this as patients and families being part of the health care team by working collaboratively with their doctor or other health care professional to be active partners when making decisions about their health.

Why is this important? Because consideration of the health, values, and goals of the individual in consultation with the entire health care team leads to an improved experience and better care. When people feel responsible for their own health and are partners with their providers in goal-setting and decision-making, they are much more likely to achieve their health care goals.

  • If individuals feel their beliefs, desires, and culture are considered in their care, they are more likely to follow their care plan.
  • If individuals are able to communicate effectively with their providers and have a prominent role in making health care decisions, they will receive better care, can more effectively manage their health, and may receive appropriate preventive care while relying less on emergency or urgent care[1].

The CMS Person and Family Engagement Strategy will serve as a guide for the implementation of person and family engagement principles and strategies throughout CMS programs. This strategy will expand the awareness and practice of person and family engagement by providing the following goals and objectives:

  • Goal 1: Actively encourage person and family engagement along the continuum of care within the broader context of health and well-being in the communities in which people live.
  • Goal 2: Promote tools and strategies that reflect person and/or family values and preferences and enable them to actively engage in directing and self-managing their care.
  • Goal 3: Create an environment where persons and their families work in partnership with their health care providers to develop their health and wellness goals informed by sound evidence and aligned with their values and preferences.
  • Goal 4: Develop meaningful measures and tools aimed at improving the experience and outcomes of care for persons, caregivers, and families. Also, identify person and family engagement best practices and techniques in the field that are ready for widespread scaling and national integration.

This Strategy emphasizes that person and family engagement goes beyond informed consent. It is about including the patients voice in policy and program planning. It is about proactive, effective communication and partnered decision-making with patients, families, and caregivers. It is about building a care relationship based on trust and inclusion of patients' beliefs, values, preferences, and culture which can even lead to a reduction in health care disparities. Health care decision-making should not always be limited to the patient and provider. It is essential to include family members, care-givers, and close friends in the conversation about health when the patient desires inclusion of others. As delivery system reform efforts move the nation to focus on the quality of care and not the quantity of care received, person and family engagement is an essential part of a health care system that delivers high quality care, spends dollars more wisely, and improves the health of people in their communities.

[1] Epstein RM, Street RL, Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. National Cancer Institute, NIH Publication No. 07-6225. Bethesda, MD, 2007.

'Building a System that Works: The Future of Health Care' new Health Affairs article by Secretary Burwell

The Centers for Medicare & Medicaid Services is sharing a new Health Affairs article by Secretary Burwell outlining her vision for the future of health care. In it, she touts collaboration with stakeholders like you in advancing crucial Delivery System Reform efforts — including ongoing Center for Medicare and Medicaid Innovation initiatives.

CMS Innovation Center announces two new models that will increase patient engagement care decision making

Today, the Centers for Medicare and Medicaid Services (CMS) announced two new models from the CMS Innovation Center. The Beneficiary Engagement and Incentives (BEI) Models -- the Shared Decision Making Model and the Direct Decision Support Model -- will test different approaches to shared decision making, acknowledging that beneficiaries make decisions regarding treatment options in a variety of ways.

The Shared Decision Making Model will test a specific approach to integrate a structured Four Step shared decision making process into the clinical practice of practitioners who are participating Accountable Care Organizations (ACOs). The shared decision making process is a collaboration between the beneficiary and the practitioner.

The Direct Decision Support Model will test an approach to shared decision making provided outside of the clinical delivery system by an organization that provides health management and decision support services.

Additional information on both of these models are now available on the Beneficiary Engagement and Incentives: General Information web page.

Quality Payment Program Qualified Clinical Data Registry (QCDR) and Qualified Registry Self- Nomination for the 2017 Performance Period is Open

To become a Qualified Clinical Data Registry (QCDR) or Qualified Registry for the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program, you must self-nominate. The self-nomination period for vendors who wish to participate as a QCDR or a Qualified Registry in MIPS for the 2017 performance period opened November 15, 2016 and will close on January 15, 2017 at 5:00 p.m. Eastern Time (ET).

The Centers for Medicare & Medicaid Services (CMS) provides detailed instructions regarding how to obtain a JIRA account, and how to complete and submit a Quality Payment Program Self-Nomination Form.  The Self-Nomination User Guide can be found here

Requirements to Self-Nominate

  1. Participants: You must have at least 25 participants by January 1, 2017. These participants don’t need to be using the QCDR/Qualified Registry to report MIPS data to us, but they need to be submitting data to the QCDR/Qualified Registry for quality improvement.
  2. Attestation Statement: You must provide a statement during the data submission period verifying that all data and results submitted to CMS are accurate and complete.
  3. Data Submission: You must submit data via a CMS-specified secure method for data submission, such as a QRDA or XML file.
  4. Data Validation Report: You must provide information on your process for data validation for both individual MIPS eligible clinicians and groups by submitting a data validation plan. Results of the executed data validation plan must be provided by May 31 of the year following the performance period.

Resources

For additional assistance to help support you in the self-nomination process, please see the QCDR/ Qualified Registry fact sheets that are available under the Education and Tools tab of the Quality Payment Program website, qpp.cms.gov.

Congress Passes 21st Century Cures Act, Bringing Forth New Era for Biomedical Innovation

December 7, 2016 

WASHINGTON, DC — FasterCures, a center of the Milken Institute, commends the U.S. Senate on today’s strong, bipartisan support of the 21st Century Cures Act (H.R. 34), which passed the Senate on a 94-5 vote, matching the U.S. House of Representatives’ vote of 392-26 on Nov. 30. The bill will now be sent to the White House. In last Saturday’s weekly address, President Barack Obama said that he would sign the bill into law as soon as it reaches his desk, enacting $4.8 billion of new funding for the National Institutes of Health (NIH) and $500 million for the Food and Drug Administration (FDA), as well as a comprehensive suite of policy provisions that will strengthen the entire biomedical innovation system.

“This landmark legislation will accelerate cures for many life-threatening diseases and help advance precision medicine,” said Michael Milken, chairman of the Milken Institute. “It assures patient-focused drug development, adds rigor to clinical trials, expands compassionate use of new drugs by dying patients, speeds the review of vaccines, addresses antibiotic resistance, responds to the opioid crisis and strengthens the nation’s research infrastructure.”

FasterCures has been honored to work with leaders in Congress, NIH and FDA throughout the bill’s journey. This is the culmination of more than two years of hard work and dedication by the bill’s bipartisan congressional champions and their staffs. House Energy and Commerce Committee Chairman Fred Upton and Representative Diana DeGette, with Ranking Member Frank Pallone, reached out to stakeholders throughout the medical research system to gather up the best ideas and translate them into legislation. Senate Health, Education, Labor and Pensions Chairman Lamar Alexander and Ranking Member Patty Murray also championed the effort and moved a set of bipartisan bills through their committee.

As the bill moved toward votes on the floors of both chambers, strong commitment from Speaker Paul Ryan, Majority Leader Kevin McCarthy and Democratic Leader Nancy Pelosi, in partnership with their Senate colleagues, Majority Leader Mitch McConnell and Democratic Leader Harry Reid, resulted in the overwhelmingly bipartisan votes we’ve seen in the past few days. Improving the biomedical innovation system is truly something that all can agree on.

“The time for medical research progress is now. We are so pleased that Congress seized this opportunity and united around this strong legislation,” said Margaret Anderson, executive director of FasterCures. “This act will invest in and strengthen the federal research system, which will support the United States’ long-standing tradition of scientific progress and hopefully spur advances for the many patients who are desperately waiting for effective treatments and cures.”

The 21st Century Cures legislation addresses the entire biomedical innovation system, and would support many of the recommendations from FasterCures’ Rx for Innovation project. Here are just a few examples from this comprehensive legislation:

  • Enhances patient centricity in biomedical product development and regulatory approval.
  • Bans efforts to block data sharing between health information systems, and provides the Department of Health and Human Services the authority to levy civil penalties against offenders.
  • Reforms FDA hiring authorities to fill the agency’s vacancies by enabling it to compete more effectively with industry to hire and retain the best and brightest experts to review medical product applications.
  • Expands the translational work done by the NIH’s National Center for Advancing Translational Sciences.
  • Catalyzes innovation in clinical trials and regulatory approval, without diminishing FDA’s authority to determine what constitutes a safe and effective medical product.

The new funding for NIH will provide $1.5 billion for the Precision Medicine Initiative, $1.8 billion for the Beau Biden Cancer Moonshot and $1.5 billion for the Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative. All of these initiatives have the potential to significantly advance our understanding of disease and identify opportunities for new therapies.

FasterCures looks forward to working with Congress, the Obama administration and the incoming Trump administration to help implement the 21st Century Cures Act, realizing its promise to support scientific breakthroughs, translate those discoveries into medical products and deliver those treatments and cures to the patients who need them. There are approximately 10,000 diseases and 500 treatments; even with today’s vote, we still have work to do.