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New Opportunities—and Challenges—in Medicare. Dr. Mark B. McClellan, M.D., Ph.D. Administrator Centers for Medicare & Medicaid Services. 21 st Century Medicare. New drug benefit New preventive benefits Empowering beneficiaries Better evidence on what works. The Drug Benefit Is Working.

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new opportunities and challenges in medicare

New Opportunities—and Challenges—in Medicare

Dr. Mark B. McClellan, M.D., Ph.D.

Administrator

Centers for Medicare & Medicaid Services

21 st century medicare
21st Century Medicare
  • New drug benefit
  • New preventive benefits
  • Empowering beneficiaries
  • Better evidence on what works
the drug benefit is working
The Drug Benefit Is Working
  • Comprehensive coverage.
  • Low cost with greater opportunities for savings.
  • 3 million prescriptions filled every day.
part d enrollment is strong
Part D Enrollment is Strong
  • More than 38 million Medicare beneficiaries—over 90%—now have prescription coverage.
  • 90% with Part D enrolled in plans other than the standard benefit designed by Congress.
intensified efforts to provide extra help
Intensified Efforts to Provide Extra Help
  • Unprecedented grassroots partnerships enabled close to 10 million people with limited incomes to have drug coverage.
  • Part D outreach spurred enrollment in other low-income programs.
  • An estimated 3.2 million low-income beneficiaries still need to enroll.
reaching low income people is a challenge
Reaching Low-Income People is a Challenge
  • Just 60 percent of seniors eligible for Medicaid are enrolled in the program now, 40 years later.
  • Only 33 percent enrollment in QMB, which began in 1988.
  • Most state prescription assistance programs enrolled only a small fraction eligible in their first years.
intensified efforts to enroll lis
Intensified Effortsto Enroll LIS

SSA:

Targeted education and application events, direct mailings, and follow-up phone calls.

NCOA:

With CMS grant, providing tailored, list-driven interventions to identify and enroll eligible beneficiaries.

intensified efforts cms
Intensified Efforts—CMS
  • LIS-eligible people do not have to wait for open enrollment.
  • Data-driven, to identify eligible people at state, county, community and individual levels.
  • Multi-pronged education and outreach.
  • Special initiatives for minority and rural people.
  • Wide array of partnerships.
important research topic
Important Research Topic:
  • Most effective strategies to reach LIS-eligible beneficiaries.
a new focus on prevention in medicare
A New Focus on Prevention in Medicare
  • Diagnose disease early when it is most treatable.
  • Manage disease so complications can be avoided.
  • Improve Medicare’s financial outlook.
new preventive services closing the benefit gap
New Preventive Services:Closing the Benefit Gap
  • “Welcome to Medicare” physical exam
  • Cardiovascular screening blood tests
  • Diabetes screening tests
  • Smoking and tobacco use cessation counseling
  • Diabetes self-management training
  • Glaucoma screening for Hispanic Americans age 65 or over
more preventive benefits
More Preventive Benefits
  • Medicare Advantage: Full “risk adjustment” leading to enhanced benefits; special needs plans
  • Medicare Health Support: Case management
  • Cancer Prevention Demonstration: To help over 13,000 minority Medicare beneficiaries navigate the healthcare system
  • In 2007: Ultrasound screening for abdominal aortic aneurysms; no deductible for colorectal cancer screening
cms prevention partnerships
CMS Prevention Partnerships
  • AoA Aging Network.
  • American Heart Association, the American Cancer Society, and the American Diabetes Association.
  • Targeted outreach with African-American, Hispanic, American Indian, Asian-American and Pacific Islander communities. This includes culturally and language-appropriate materials and specialized paid media campaigns.
some cms beneficiary resources
Some CMS Beneficiary Resources
  • www.Medicare.gov
  • Medicare Compare tools
  • 1-800-MEDICARE
  • Medicare & You Handbook
  • http://My.Medicare.gov
added steps to person centered care
Added Steps toPerson-Centered Care

Transparent, accessible information on:

  • Coverage
  • Prevention
  • Quality and cost
coverage with evidence development
Coverage with Evidence Development
  • Registries
  • Clinical Trials
  • CED Draft Guidance
key research issues
Key Research Issues
  • Best practices in assisting limited-income beneficiaries.
  • How to better assist beneficiaries in choosing drug coverage.
  • Best steps to close prevention gap.
  • How to help people with Medicare to use all their coverage effectively.
  • How to improve evidence.