|
Today, under the
leadership of President Trump, the Centers for Medicare & Medicaid
Services (CMS) is calling for a renewed national commitment to value-based
care based on Medicare claims data that provides an early snapshot of the
impact of the coronavirus disease 2019 (COVID-19) pandemic on the Medicare
population. The data shows that older Americans and those with
chronic health conditions are at the highest risk for COVID-19 and confirms
long-understood disparities in health outcomes for racial and ethnic
minority groups and among low-income populations.
“The disparities in the
data reflect longstanding challenges facing minority communities and low
income older adults, many of whom face structural challenges to their
health that go far beyond what is traditionally considered ‘medical’,” said
CMS Administrator Seema Verma. “Now more than ever, it is clear that our
fee-for-service system is insufficient for the most vulnerable Americans
because it limits payment to what goes on inside a doctor’s office. The
transition to a value-based system has never been so urgent. When
implemented effectively, it encourages clinicians to care for the whole
person and address the social risk factors that are so critical for our
beneficiaries’ quality of life.”
The data released today
includes the total number of reported COVID-19 cases and hospitalizations
among Medicare beneficiaries between January 1 and May 16, 2020. The
snapshot breaks down COVID-19 cases and hospitalizations for Medicare
beneficiaries by state, race/ethnicity, age, gender, dual eligibility for
Medicare and Medicaid, and urban/rural locations. The new data show that
more than 325,000 Medicare beneficiaries had a diagnosis of COVID-19
between January 1 and May 16, 2020. This translates to 518 COVID-19 cases
per 100,000 Medicare beneficiaries. The data also indicate that nearly
110,000 Medicare beneficiaries were hospitalized for COVID-19-related
treatment, which equals 175 COVID-19 hospitalizations per 100,000 Medicare
beneficiaries.
Blacks were hospitalized
with COVID-19 at a rate nearly four times higher than whites. The
disparities presented in the snapshot go beyond race/ethnicity and suggest
the impact of social determinants of health, particularly socio-economic
status.
Other key data points:
- End-stage
renal disease (ESRD) patients (individuals with chronic kidney disease
undergoing dialysis) had the highest rate of hospitalization among all
Medicare beneficiaries, with 1,341 hospitalizations per 100,000
beneficiaries. Patients with ESRD are also more likely to have chronic
comorbidities associated with increased COVID-19 complications and hospitalization,
such as diabetes and heart failure.
- The
second highest rate was among beneficiaries enrolled in both Medicare
and Medicaid (also known as “dual eligible”), with 473
hospitalizations per 100,000 beneficiaries.
- Among
racial/ethnic groups, Blacks had the highest hospitalization rate,
with 465 per 100,000. Hispanics had 258 hospitalizations per 100,000.
Asians had 187 per 100,000 and whites had 123 per 100,000.
- Beneficiaries
living in rural areas have fewer cases and were hospitalized at a
lower rate than those living in urban/suburban areas (57 versus 205
hospitalizations per 100,000).
The snapshot also shows
that besides higher hospitalization rates, beneficiaries enrolled in both
Medicaid and Medicare have a higher infection rate of COVID-19, with 1,406
cases per 100,000 beneficiaries. By comparison, the coronavirus infection
rate for beneficiaries enrolled only in Medicare is 325 cases per 100,000.
The rate of COVID-19 cases for dual eligible individuals is higher across
all age, sex, and race/ethnicity groups. Previous research has shown that
these individuals experience high rates of chronic illness, with many
having long-term care needs and social risk factors that can lead to poor
health outcomes.
Given the complexity of
these disparities, any solution requires a multi-sectoral approach that
includes federal, state, and local governments, community based
organizations, and private industry. One piece of this is the increased
implementation of a value-based system that rewards providers for keeping
patients healthy and gives consumers the information about disease
prevention and outcomes needed to help make healthcare choices on the basis
of quality. Additionally, CMS is encouraging states to double down on
efforts to protect low income seniors and look at the data and determine
what resources are available, both locally and federally, to improve this
disparity of health outcomes. CMS has identified a range of operational
opportunities for states to improve care for dually eligible individuals
and a variety of models that states can participate in that focus on
improving the quality and cost of care for individuals who are concurrently
enrolled in Medicaid and Medicare.
The Center for Medicaid
and Children’s Health Insurance Program (CHIP) Services is developing
guidance for states on new opportunities to adopt innovative, value-based
payment design and implement strategies to address social determinants of
health for their beneficiaries, including those who are dually-eligible for
Medicare and Medicaid. In addition to these ongoing efforts and programs,
the CMS Office of Minority Health will be holding a series of listening
sessions with key stakeholders responsible for providing care to racial and
ethnic minorities. These listening sessions are intended to help refine the
ongoing outreach and work by CMS to improve future efforts on this issue.
CMS typically releases
Medicare claims information on an annual basis when there are more complete
claims and encounter data. However, as part of the agency’s efforts to
provide data transparency during the pandemic and ensure the public has
this vital information as soon as it is available, CMS is releasing this
preliminary data now. The data will be updated on a monthly basis as more
claims and encounter records are received. CMS anticipates releasing
similar information on Medicaid beneficiaries in the future.
|
No comments:
Post a Comment