New opportunities and challenges in medicare
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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.


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


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


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


  • Medicare Compare tools

  • 1-800-MEDICARE

  • Medicare & You Handbook


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.