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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