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Finance Team National Hispanic Medical Association Leadership Fellowship 2003. Jose Castro MD Elsa Escalera MD Inginia Genao MD Advisor: Charles Brecher PhD. The New Medicare Law: Implications for vulnerable population. Outline.

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Finance team national hispanic medical association leadership fellowship 2003

Finance TeamNational Hispanic Medical AssociationLeadership Fellowship 2003

Jose Castro MD

Elsa Escalera MD

Inginia Genao MD

Advisor: Charles Brecher PhD


The new medicare law implications for vulnerable population

The New Medicare Law:Implications for vulnerable population


Outline
Outline

  • Overview Medicare prescription drug improvement and modernization act of 2003

  • Impact on the dual eligibles (Medicaid and Medicare)

  • Recommendations

  • Summary


Overview of the medicare prescription drug improvement and modernization act of 2003
Overview of the Medicare prescription drug improvement and modernization act of 2003.

  • 41.7 million beneficiaries of Medicare to new coverage of prescription drugs

  • $ 410 billion (calculated by CBO) 2004-2013

  • Voluntary benefit effective January 1, 2006

  • Annual premium in 2006 about $420—can vary by plan

  • Annual $250 deductible indexed to drug spending

  • Coverage gap (“donut hole”)—no coverage for spending between $2,250 and $5,100

  • Subsidies for low-income beneficiaries


Standard drug benefit
Standard Drug Benefit modernization act of 2003.


Dual eligibles
Dual Eligibles modernization act of 2003.


Sources of supplemental coverage among non institutionalized medicare beneficiaries 2000
Sources of Supplemental Coverage modernization act of 2003.Among Non-InstitutionalizedMedicare Beneficiaries, 2000

* Includes Medicaid, Veteran Affairs, and various other programs.

Source: Analysis of 2000 MCBS by Bruce Stuart for The Commonwealth Fund.


Dual eligibles who are they
Dual eligibles: Who Are They? modernization act of 2003.

  • Medicaid fill gaps in Medicare > 7 million low-income seniors: enrolled in both Medicaid/Medicare.

  • Must have income well bellow the poverty line and minimal assets to qualify for Medicaid,

  • Dual eligibles are much poorer than other Medicare beneficiaries.

  • They also tend to have far more extensive health care needs than other Medicare beneficiaries:


Dual eligibles how poor how sick
Dual Eligibles: How poor, how sick? modernization act of 2003.

  • 70% of dual eligibles have annual incomes < $ 10 K compared to 13 % of all other Medicare beneficiaries.

  • More than twice as likely to be in fair or poor health as other Medicare beneficiaries (52% versus 24%).

  • ~ 25% of dual eligibles are in long-term care facilities compared to 2% of other Medicare beneficiaries.

  • Dual eligibles are more than twice as likely to have Alzheimer’s (6% versus 3%), more likely to have diabetes (24% versus 17%) and to have suffered a stroke (14% versus 11%) than other Medicare beneficiaries.


New medicare law for dual eligibles
New Medicare Law for Dual eligibles modernization act of 2003.

  • No deductible and no premium for enrolling in an average or low cost plan.

  • Special assistance with cost-sharing obligations (no doughnut hole for dual eligibles). Will not pay for 100% once they exceed limit of $2,250.

  • Oincome up to 100% of poverty: no more than $1/generic and $ 3/brand name drug in 2006. Majority will fall into this category.

  • O       dual eligibles with income >100% of poverty. $2/generic and $5/brand name drug in 2006.


Impacts on dual eligibles should the fight continue
Impacts on Dual Eligibles: Should the Fight Continue? modernization act of 2003.

  • Complex choices

  • Navigating the system

  • Variations from state to state

  • Drug coverage restrictions under part D plan

    • Array of drugs covered

    • Cost-sharing


Iii recommendations
III Recommendations modernization act of 2003.

  • Focus in Hispanics: will have additional challenges.

  • Measuring outcomes.


Finance team national hispanic medical association leadership fellowship 2003

  • In 2002, almost 2 million Hispanics > 65 ys. modernization act of 2003.

  • Data gathering should be focused on this group to estimate the impact the new Medicare law.

  • Data should be the best advocacy tool.

  • One way to obtain reliable data is research.


Outcomes research
Outcomes research modernization act of 2003.

  • Outcome research: measures outcomes.

  • Set of analytic methods that produce information about the benefits, risks, and costs of health care services.


Measuring outcomes
Measuring outcomes modernization act of 2003.

  • There are many potential measurements that can be incorporated in the study, but should be oriented to the particular characteristics of the study population, for example:

  • Measure Example

  • Mortality cardiovascular associated mortality

  • Physiology blood pressure

  • Clinical events stroke

  • Functional status SF-36, a 36 item health survey

  • Experience with care Consumer Assessment of Health Plan


Summary
Summary modernization act of 2003.

  • Good benefits for many beneficiaries.

  • May be a challenge for the most vulnerable, in particular Hispanics.

  • Outcome research focus in this population and plan in advance.


Finance team national hispanic medical association leadership fellowship 2003


Finance team national hispanic medical association leadership fellowship 2003