New Opportunities—and Challenges—in Medicare Dr. Mark B. McClellan, M.D., Ph.D. Administrator Centers for Medicare & Medicaid Services
21st Century Medicare • New drug benefit • New preventive benefits • Empowering beneficiaries • Better evidence on what works
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 • 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 • 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 • 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 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 • 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: • Most effective strategies to reach LIS-eligible beneficiaries.
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 • “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 • 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 • 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 • www.Medicare.gov • Medicare Compare tools • 1-800-MEDICARE • Medicare & You Handbook • http://My.Medicare.gov
Added Steps toPerson-Centered Care Transparent, accessible information on: • Coverage • Prevention • Quality and cost
Coverage with Evidence Development • Registries • Clinical Trials • CED Draft Guidance
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.