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Enhancing Value in Medicare

Enhancing Value in Medicare. Stuart Guterman Senior Program Director Program on Medicare’s Future The Commonwealth Fund Bipartisan Health Policy Conference Miami, FL January 14, 2007. Medicare Spending as a Share of GDP is Growing Steadily, and Expected to Increase Sharply.

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Enhancing Value in Medicare

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  1. Enhancing Value in Medicare Stuart Guterman Senior Program Director Program on Medicare’s Future The Commonwealth Fund Bipartisan Health Policy Conference Miami, FL January 14, 2007

  2. Medicare Spending as a Share of GDP is Growing Steadily, and Expected to Increase Sharply Source: Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Insurance Trust Funds. 2006 Annual Report. (Washington, DC: Boards of Trustees, May 1, 2006):33.

  3. Two-Thirds of Medicare Spending is for People With Five or More Chronic Conditions Source: G. Anderson and J. Horvath, Chronic Conditions: Making the Case for Ongoing Care (Baltimore, MD: Partnership for Solutions, December 2002)

  4. Medicare Spending per Enrollee HI MN AK CO OR UT DC ID NH AZ MD FL CA DE WY NV NM VT WI SC VA SD NY IA WA US MT IN KS MI ND CT TX NE ME MA NJ NC IL WV KY OH GA AR MS MO AL PA LA TN OK RI Medicare Spending Per Enrollee and Mortality Rates Don’t Appear to be Related Mortality Rate of Medicare Enrollees Source: Data from The Dartmouth Atlas of Health Care, www.dartmouthatlas.org

  5. Efforts to Enhance Value in Medicare • Better coordination of care for chronically ill beneficiaries • Traditional Medicare • Medicare Advantage • Better incentives for quality improvement: collecting information • Post information on performance • Study relation of process to outcomes • Indicate what improvements are needed • Better incentives for quality improvement: paying for performance • Encourage desired behavior • Counter adverse incentives

  6. Developing Improvements: Medicare Demonstrations • Increase clarity and flexibility in the waiver approval process • Expand the array of methods available for evaluating demonstration results • Establish a more explicit and transparent mechanism for moving from pilot to policy

  7. Areas in Which Value Can Be Enhanced • Medicare Prescription Drug Benefit • Reaching more beneficiaries (particularly low income) • Better access to low income subsidy (asset test) • Better coordination with medical care • Help beneficiaries get the best deal • Physician Payment • The SGR problem: how to control spending without distorting prices? • Pay-for-performance (quality and efficiency) • Medicare Advantage • Extra payments • Variation in beneficiary liability • Help beneficiaries get the best deal

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