CMS is working with partners and technology developers to
address the social determinants of health for seniors, including poverty and
care access.
By Jessica Kent
February 06, 2019 - To
drive down healthcare costs for Medicare beneficiaries, CMS is expanding
policies to reduce prescription drug prices, increase community partnerships,
and foster technological innovations that will address poverty and other social
determinants of health among the elderly.
These advancements
are necessary, as older adults often face significant poverty challenges, said
Cara V. James, Director of the CMS Office of Minority Health, and Tim
Englehardt, Director of the Federal Coordinated Health Care Office, in a recent
blog post.
“Poverty impacts
millions of older Americans,” the pair wrote.
“One in four
Medicare beneficiaries has less than $15,000 in total savings, and almost one
in 12 has no savings or is in debt. There remain wide disparities among racial
and ethnic groups: median per capita savings among white Medicare beneficiaries
is more than six times greater than among either black or Hispanic
beneficiaries.”
James and Englehardt
noted that even with Medicare coverage, beneficiaries still struggle with high
out-of-pocket costs. Among beneficiaries with incomes below the federal poverty
level, 38.7 percent spend more than one-fifth of their annual incomes on
premiums and out-of-pocket medical expenses.
To ensure
beneficiaries are protected from sky-high out-of-pocket costs, CMS is working
to increase price transparency for prescription drugs. In November 2018, CMS expanded
policies that help beneficiaries save on prescription drugs administered in
certain hospitals.
Additionally, CMS recently
proposed policies that would ensure Medicare Part D and Medicare
Advantage plans have tools to negotiate lower drug prices, which will also help
lower out-of-pocket costs.
The organization
also recently asked for public
comment on an innovative drug pricing model, which would reduce
Medicare spending for physician-administered drugs in Part B, as well as
improve care quality.
The agency is
focusing on initiatives that will address non-clinical factors as well.
“Recognizing the
need for local innovation and the interconnectedness of health and social
services, we are working on integrating services and addressing social
determinants through Innovation Center models,” James and
Englehardt said.
One such model, the
Accountable
Health Communities Model, aims to promote clinical-community
collaboration by screening beneficiaries to identify unmet health-related
social needs. Over a five-year period, the model will provide support to
community organizations that link beneficiaries with services that address the
social determinants of health.
CMS is also
collaborating with community organizations to promote existing programming that
can help reduce the high costs of care.
“States, advocates,
and community organizations can also help connect low-income Medicare
beneficiaries with programs that help with Medicare premiums and cost sharing:
the Medicare Savings
Programs and Extra Help,”
the authors said.
“Most of the
state-based Medicare Savings Programs can save beneficiaries over $1,600 a year
just by covering Medicare Part B premiums – money beneficiaries can use for
food, housing, or other necessities.”
James and
Englehardt noted that while millions of Americans qualify for Medicare Savings
Programs, many are not yet enrolled.
States can take steps
to simplify the enrollment process for beneficiaries, including simplifying the
collection of data from beneficiaries, as well as providing adequate assistance
to those enrolling in one of these programs.
CMS is also
enabling beneficiaries to access affordable care in new, innovative ways.
“In Medicare – as
with other forms of coverage – individuals can reduce their risk of high
out-of-pocket costs by accessing free preventive services and
actively shopping for the best value among Medicare’s options for health plans
and drug coverage,” the authors said.
“CMS is focused on
consumer empowerment and has created a suite of tools through the eMedicare
initiative that we believe can assist cost-conscious senior as they seek out
high value care.”
The recently
launched “What’s Covered” app, part of the eMedicare initiative,
allows beneficiaries, caregivers, and others to quickly see whether medical
services and items are covered under Medicare. Consumers can use their mobile
devices to get accurate, consistent information about services offered in
doctors’ offices, hospitals, and other healthcare settings.
With these
advancements, CMS is aiming to lower healthcare costs for Medicare
beneficiaries while also improving care quality.
“Through innovation,
partnership and a strong focus on making health care more affordable, we have
the tools to further reduce senior poverty across the country,” James and
Englehardt concluded.
“States interested
in promoting access to programs or learning more about how to streamline
administrative processes for the Medicare Savings Programs should contact their
CMS Regional Office. States can also encourage beneficiaries to contact
their local State Health
Insurance Assistance Program (SHIP) or visit
the Medicare Savings Programs and Extra Help CMS webpages.”
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