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To the editor: The nation's 56 independent Blue Cross & Blue Shield Plans agree that the recently enacted Medicare reforms make important strides toward improving the program ("Medicare Reform Merits Praise," Sept. 15). But, we believe the debate must move forward to more carefully examine the quality of health care delivered to older Americans.

So far, most of the debate about preparing Medicare for the 21st century has focused on cost and benefit design issues. Beyond that, the scope of health services for seniors should be expanded to focus not only on treating chronic diseases, but also on the unique aspects of wellness and risk screening for older adults.

That's why the Blue Cross & Blue Shield System has joined forces with the American Geriatrics Society to create the National Blue Initiative for Quality Senior Care. Together, we will provide primary care physicians with expertise and the latest clinical knowledge in geriatric medicine. Our goal is to help physicians implement this expertise in their day-to-day practices so they can improve the quality and effectiveness of care they provide to older adults. This initiative represents the next critical step in improving the quality of care for seniors.

Patrick G. Hays

President and Chief Executive Officer

Blue Cross & Blue Shield Assn.