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Advanced Medicare Concepts

Learn about latest updates on Medicare accreditation, enrollment statistics, financial outlook, CMS strategies, MACRA implementation, and payment changes. CMS is focusing on accountability and transparency to improve patient care and safety.

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Advanced Medicare Concepts

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  1. Advanced Medicare Concepts Presented by Mike Smith, LTCP, SGS President, The Brokerage, Inc.

  2. Agenda • Accreditation Organizations • eMedicare • Medicare Enrollment Statistical Update • 10 Essential Facts About Medicare’s Financial Outlook • CMS Quality Strategy • CMS Person and Family Engagement Strategy • MACRA • CMS Quality Payment Program

  3. CMS to Strengthen Oversight of Medicare’s Accreditation Organizations (AO) October 4, 2018, Contact: CMS Media Relations, (202) 690-6145 • DHHS website will increase transparency into Accrediting Organization performance and CMS will • CMS will streamline & strengthen the validation of AO surveys • CMS took action to improve quality and safety in healthcare facilities and empower patients with info to make decisions about where to receive care

  4. CMS Is Moving Forward with Medicare Payment Changes; Will Improve Transparency For ACOs • Adam Boehler, head of CMS’ Center for Medicare and Medicaid Innovation: • CMS is pushing forward with controversial changes to experimental payment programs in Medicare, while also considering ways to improve transparency and predictability • Is working to improve shortcomings in the administration’s evaluations of accountable care organizations, or ACOs • “only fair to ask for a transparent and simple model if we’re asking for accountability.” Source: Congressional Quarterly, Oct 2018

  5. Accreditation Organizations (AOs) • Currently, Medicare-participating healthcare providers and suppliers are surveyed either by State survey agencies or by Accrediting Organizations (AOs) to ensure that they meet CMS’ quality and safety standards • AOs receive deeming authority from CMS, which affirms that AOs’ health and safety standards meet or exceed those of Medicare • Only facilities and suppliers that have been deemed by state or AO surveyors to meet CMS’ standards may receive payments from Medicare • There are currently 10 CMS-approved AOs, each of which surveys one or more different types of facilities

  6. AOs - continued CMS will enhance and strengthen its oversight and quality transparency of AOs in three ways: • The public posting of AO performance data • a redesigned process for AO validation surveys and • The release of the Annual Report to Congress Taken together, these efforts will provide important insights to the public and assist AOs, providers, and suppliers in ensuring patient health and safety 

  7. AOs - continued • To increase transparency for consumers, CMS will post new information on the CMS.Gov website, including: • The latest quality-of-care deficiency findings following complaint surveys at facilities accredited by Aos • a list of providers determined by CMS to be out of compliance, with information included on the provider’s AO • and overall performance data for AOs themselves To view AO performance data, visit: https://qcor.cms.gov/hosp_cop/HospitalCOPs.html

  8. AOs - continued • Today, the public relies on accreditation status as a way to gauge providers’ and suppliers’ quality of care • By posting more detail—accredited hospitals’ complaint surveys, out-of-compliance information, and performance data for AOs themselves—CMS will offer the public more nuanced information than accreditation status alone provides • The agency is currently prohibited by law from disclosing the actual surveys done by AOs, except for surveys of home health agencies and surveys related to an enforcement action

  9. CMS Announces New Streamlined User Experience for Medicare Beneficiaries October 1, 2018, Contact: CMS Media Relations, (202) 690-6145 | CMS Media Inquiries • Today, the Centers for Medicare & Medicaid Services (CMS) announced a multi-year initiative that will empower patients and update Medicare resources to meet beneficiaries’ expectation of a more personalized customer experience

  10. eMedicare • The eMedicare initiative will modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families • The eMedicare initiative’s goal is to provide a seamless online health care experience to meet the growing expectations for this generation of Medicare beneficiaries

  11. eMedicare - continued • CMS has a cohesive, multi-year strategy of consumer data integration and web product development to modernize Medicare.gov and improve access to personal health care data • The road map for this program will enhance opportunities to • go digital • offer additional self-serve options and • create a seamless multi-channel customer service experience 

  12. New eMedicare initiatives that CMS is launching ahead of Medicare Open Enrollment are: • An improved coverage wizard to help beneficiaries compare options at a deeper level as a way to decide if Original Medicare or Medicare Advantage is right for them • A stand alone, mobile optimized out of pocket cost calculator that will provide information on both overall costs and prescription drug costs

  13. New eMedicare initiatives that CMS is launching ahead of Medicare Open Enrollment are: • A simplified log in for the Medicare Plan Finder (https://www.medicare.gov/find-a-plan/questions/home.aspx) tool using their online account (instead of the current process of entering 5 pieces of information to authenticate) • A webchat option, which will be available within the Medicare Plan Finder for some beneficiaries and • New easy to use surveys available across Medicare.gov so beneficiaries can continue to tell us what they want

  14. These changes are building on previous improvements including: • Giving beneficiaries the ability to print their Medicare card online • Re-designing the Mymedicare.gov homepage for easier navigation • Launching consumer-facing Blue Button (https://www.medicare.gov/manage-your-health/medicares-blue-button-blue-button-20) features in Mymedicare.gov • Providing an online version of the Medicare & You Handbook (https://www.medicare.gov/medicare-and-you) in a mobile-friendly format. We’ve also added simple, graphical explanations at the beginning of the Medicare & You handbook

  15. These changes are building on previous improvements including: • Improving email communications • Medicare emails more than 8 million beneficiaries with information about Open Enrollment, preventive benefits, money saving tips, and fraud prevention • Enhancing social media presence—Medicare’s Facebook page (https://www.facebook.com/medicare/) has grown to almost 500K followers • Distributing the electronic version of the Medicare Summary Notice, allowing people with Medicare to view their explanation of benefits in a more timely manner online at Mymedicare.gov (https://www.mymedicare.gov/) and • The eMedicare initiative will expand and improve upon current consumer service options. People with Medicare will continue to have access to paper

  16. The Medicare Red Tape Relief Project (8-15-18) • Washington, D.C. –  House Ways and Means Chairman Kevin Brady (R-TX) and House Ways and Means Subcommittee on Health Chairman Peter Roskam (R-IL), released a report discussing how lawmakers and the Administration can cut excessive red tape and regulatory burdens in the Medicare program

  17. The Medicare Red Tape Relief Project (8-15-18) • This report is the result of the Committee’s “Medicare Red Tape Relief Project.” • This initiative, as part of the Committee’s ongoing efforts to modernize and improve the Medicare program • Identified opportunities to reduce legislative and regulatory burdens on Medicare providers • Improves the efficiency and quality of the Medicare program for seniors and individuals with disabilities

  18. The Medicare Red Tape Relief Project has three stages: • Stage One: Request feedback from stakeholders to learn more about the policies that improve health care – and the policies that stand in the way • Stage Two: Host roundtables with stakeholders to continue the conversations and identify solutions; and • Stage Three: Take Congressional action based on feedback from stakeholders and dialogue with the Administration

  19. How are Medicare Advantage plans performing? Does the public like them or not?

  20. Avalere Report • The prominent research firm Avalere recently published a major study showing that Medicare Advantage generally outperformed traditional Medicare • This was especially so in caring for the most challenging patients who suffer from chronic conditions and complicated medical problems • The availability of more comprehensive data shows that Medicare Advantage is, in fact, a genuine advantage for Medicare beneficiaries https://www.bettermedicarealliance.org/sites/default/files/2018-07/BMA_Avalere_MA_vs_FFS_Medicare_Report_0.pdf

  21. Avalere Report • As this latest Avalere study indicates, Medicare Advantage is more cost-effective than traditional fee-for-service Medicare, especially in treating patients with complex medical problems • The availability of more comprehensive data shows that Medicare Advantage is, in fact, a genuine advantage for Medicare beneficiaries • As this latest Avalere study indicates, Medicare Advantage is more cost-effective than traditional fee-for-service Medicare, especially in treating patients with complex medical problems

  22. Humana will pay you to take better care of yourself!

  23. Strong Medicare Advantage Enrollment • About 35% of the current 55.5 million Medicare beneficiaries are enrolled in a Medicare Advantage plan • The final results from the 2017 Annual Election Period (AEP) indicate strong growth in Medicare Advantage • About 19.5 million seniors are now enrolled • The MA program is growing at a slightly faster pace than it has in recent years http://kaiserf.am/2nIhX9g

  24. Growing Medicare Enrollment • 11,568* Americans entering Medicare every day • *based on 76MM “Baby Boomers”  • 2015 - 55,500,000 people were enrolled in Medicare • By 2020, that number is expected to increase to 64.4 million • By 2030 - 81,800,000

  25. Watch Out for the Funding Liabilities! Medicare Cost Per Person, Per Month: Part A cost = $413 in 2017 Part B cost = $429 (most people pay about $134 of this cost) Part D Cost = $76 (estimated per person, per month) • Total cost per beneficiary is estimated to be $918 per month, or $11,016 per year • 11,568 people turning age 65 every day = 4,222,320 people per year • $11,016 x 4,222,320 = $46,513,077,120 is a lot of money!

  26. 2.95% increase for 2018; 3.41% in 2019

  27. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 1. Medicare isn’t “going broke” even though it does face financial challenges • Currently, Medicare’s actuaries estimate that there will be sufficient funds available to pay for hospital insurance benefits in full until 2028 • At that point, Medicare will be able to cover 87% of costs covered under Part A through payroll tax revenues—but the Medicare program will not cease to operate

  28. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 2. The aging U.S. population, along with higher health care costs, are contributing to the growth in Medicare spending over time • Between 2010 and 2050, the population ages 65 and older will double, from about 40 million to 84 million people • People age 80 and over account for a disproportionate share of Medicare spending

  29. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 3. The ACA helped to reduce Medicare spending growth in the years following its enactment Average annual growth in spending per beneficiary averaged 1.4% between 2010 and 2015, down from 7.4% between 2000 and 2010

  30. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 4. Repealing the ACA, including all Medicare provisions, would increase Medicare spending According to the CBO, repealing the ACA in its entirely would add $802 billion to Medicare spending over 10 years

  31. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 5. Medicare spending was 15% of the federal budget in 2016 • Net Medicare spending in 2016 was $588 billion • That is, spending on benefits minus premiums from beneficiaries and other receipts • This represents 15% of the $3.9 trillion federal budget that year, or $1 out of every $7 in federal spending

  32. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 6. Medicare spending is projected to increase gradually as a share of the federal budget and the nation’s economy over the next 10 years • In 2027, Medicare spending will account for 18% of the federal budget—or $1 out of every $6 in federal spending—and 4.2% of the economy • Between 2017 and 2027, net Medicare spending will nearly double, from $588 billion to $1.2 trillion

  33. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 7. Medicare spending is projected to increase at a faster rate in the coming years than in the five years following enactment of the ACA On a per capita basis, Medicare spending is expected to grow at an average annual rate of 4.3% between 2015 and 2025, faster than the 1.4% growth rate between 2010 and 2015

  34. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 8. Spending on Part D prescription drug coverage is expected to grow faster than spending on other Medicare-covered benefits over the next 10 years Between 2015 and 2025, per capita spending growth is projected to be: • 5.8% for Part D • 3.2% for Part A • 4.6% for Part B

  35. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 9. Medicare spending is projected to increase as a share of the economy over the long run, but the ACA helped to moderate the long-range projections • According to the CBO’s long term projections, net Medicare spending will grow from 3.2% of GDP in 2016 to 5.7% in 2046 • Prior to the ACA, Medicare spending was projected to grow more rapidly as a share of the nation’s economy, reaching 8.5% by 2046

  36. 10 Essential Facts About Medicare’s Financial Outlook – www.KFF.org 10. Medicare benefits are funded mainly by a combination of general revenues, payroll taxes, and premiums paid by beneficiaries • The Hospital Insurance (Part A) trust fund is only one part of Medicare, funded primarily by payroll taxes • Benefits for Part B and Part D are paid for separately through a combination of general revenues and beneficiary premiums

  37. CMS Quality Strategy • Centers for Medicare & Medicaid Services (CMS), is working with numerous partners to transform our health care delivery system to one that delivers better health outcomes while spending dollars more wisely • In November of 2015, CMS updated the CMS Quality Strategy, incorporating the ongoing work to shift Medicare from paying for the number of services provided to paying for better outcomes for patients

  38. CMS Quality Strategy One of the six goals outlined in this strategy is to: “Strengthen person and family engagement as partners in care” What does person and family engagement mean? Patients and families being part of the health care team by working collaboratively with their doctor or other health care professional to be active partners when making decisions about their health

  39. Why is this important? • If individuals feel their beliefs, desires, and culture are considered in their care, they are more likely to follow their care plan • If individuals are able to communicate effectively with their providers and have a prominent role in making health care decisions, they will: • receive better care • can more effectively manage their health • and may receive appropriate preventive care while relying less on emergency or urgent care

  40. CMS Person and Family Engagement Strategy Goal 1: Actively encourage person and family engagement along the continuum of care within the broader context of health and well-being in the communities in which people live Goal 2: Promote tools and strategies that reflect person and/or family values and preferences and enable them to actively engage in directing and self-managing their care. 

  41. CMS Person and Family Engagement Strategy Goal 3: Create an environment where persons and their families work in partnership with their health care providers to develop their health and wellness goals informed by sound evidence and aligned with their values and preferences

  42. CMS Person and Family Engagement Strategy Goal 4: Develop meaningful measures and tools aimed at improving the experience and outcomes of care for persons, caregivers, and families Also: identify person and family engagement best practices and techniques in the field that are ready for widespread scaling and national integration

  43. CMS Person and Family Engagement Strategy • Goal 5: Move the nation to focus on the quality of care and not the quantity of care received • Person and Family Engagement is an essential part of a health care system that delivers: • High quality care • Spends dollars more wisely • Improves the health of people in their communities

  44. New Medicare Quality Payment Program Part of MACRA

  45. MACRA – Medicare Access & CHIP Reauthorization Act • Replaces Medicare’s Sustainable Growth Rate formula on Jan. 1, 2017 • Payments under MACRA do not actually kick in until 2019, but providers must start meeting their performance targets next year • Is meant to modernize and streamline physician payments under a new quality-based system • Keep in mind MACRA also: • Implements changes to Medicare ID cards starting April 2018 • Plan F will no longer be available to new enrollees after 1-1-20

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