Health care law saved an estimated $2.1 billion for consumers

The health care law – the Affordable Care Act – has saved consumers an estimated $2.1 billion on health insurance premiums according to a new report released today by the Department of Health and Human Services. For the first time ever, new rate review rules in the health care law prevent insurance companies in all states from raising rates with no accountability or transparency. To date, rate review has helped save an estimated $1 billion for Americans. Additionally, the law’s Medical Loss Ratio (or 80/20) rule is helping deliver rebates worth $1.1 billion to nearly 13 million consumers. Read More >>

For More Information

Read more about the Affordable Care Act at HealthCare.gov and find out what’s changing and when

The New Medicare.gov: Making Medicare Information Clearer & Simpler

Did you ever get a government notice you didn’t understand? Have you ever gone to a website and hunted and clicked forever to find what you were looking for—or even worse, leave empty handed? We know how frustrating it can be, which is why we’ve given Medicare.gov  a new design that makes it faster and easier to get answers to Medicare questions.

We know Medicare.gov is your trusted source of online Medicare information. That’s why we worked more than 2 years on improving it. We listened to the people who use our website – people like you – and used their feedback to make the website better.

The new Medicare.gov includes features not available before, like:

  • Many ways for you to do the most common tasks, like finding out about costs, coverage, and plans, through several paths — right from the homepage, so you can spend more time helping people with the tougher questions
  • Action-oriented labels to help you get the latest information faster
  • Design that works on mobile devices, like tablets and smartphones, so you can get information anytime, anywhere, and in the most convenient format for you

The new Medicare.gov is just one of our efforts to make Medicare easier to understand. Whether it’s putting our information in simple, straightforward language so you can understand it the first time you read it or improving the design of the “Medicare Summary Notice” (MSN) so beneficiaries can better understand their Medicare claims, we’re committed to making Medicare information clearer and simpler.

Check it out and tell us how we did—send us a tweet (use #medicaredotgov).

Command Center Speeds Up Anti-Fraud Efforts

By Dr. Peter Budetti, CMS Deputy Administrator and Director of the Center for Program Integrity

Today, I had the privilege of joining HHS Secretary Kathleen Sebelius and CMS Acting Administrator Marilyn Tavenner to open the new CMS Program Integrity Command Center that is speeding up the process of identifying fraud, and stopping criminals from defrauding Medicare and Medicaid.

The new Command Center is bringing together Medicare and Medicaid officials, as well as law enforcement partners from the HHS Office of the Inspector General, the Federal Bureau of Investigation, and CMS’s anti-fraud investigators. The Command Center will gather experts from all different areas – clinicians, data analysts, fraud investigators, and policy experts – into the same room to build and improve our sophisticated new predictive analytics that spot fraud, and to then move quickly on a lead, once potential fraud is identified. The technology also allows us to connect with field offices to track down leads in real time.

The result is that investigations that used to take days and weeks can now be done in a matter of hours. And this new technology can help detect and prevent potential problems and payments. That can mean millions of taxpayer dollars staying out of the hands of fraudsters.

This is one more part of the Obama Administration’s effort to fight fraud and waste in our health care system. The health reform law gives law enforcement more tools to go after fraudsters, and establishes tougher sentences once we catch those criminals. We’re already seeing results – four years ago, the government recovered just over $1 billion in fraudulent payments; this year, it’s over $4 billion, a record number. We’ve had the largest health care fraud busts in history in 2012.

Below, view a preview of this exciting facility that’s helping us protect the Medicare and Medicaid programs:

Supporting Every Provider in Delivering Better, More Coordinated, Patient-Centered Care

By Dr. Rick Gilfillan, Director, Center for Medicare & Medicaid Innovation

This month, 88 new Accountable Care Organizations (ACOs) joined the other Medicare Shared Savings Program ACOs that came on line earlier this year.  Now, more than 150 organizations are partnering with Medicare in shared savings initiatives and offering more than 2 million patients better, more coordinated, patient-centered health care.

At the Centers for Medicare & Medicaid Services (CMS), we see ACOs as part of the future of health care—part of a broader movement from the old fee-for-service system that simply paid more for more services regardless of the outcome, to one that rewards providers for high-quality, coordinated care. 

Providers also see ACOs as a path to better health care.   During the rulemaking process for the Medicare Shared Savings Program, our agency heard from many small practices who wanted to become ACOs, but needed additional capital to meet the high bar for care coordination required of an ACO.  

We want to make sure that healthcare providers interested in forming ACOs have the opportunity to do so.  That’s why we created the Advance Payment Model—to provide entities such as rural and physician-owned organizations that hope to become ACOs in the Medicare Shared Savings Program with the support they need to invest in staff and in health information technology.  They will repay Medicare through savings they achieve.

Last week, CMS was proud to announce the second group of fifteen Advance Payment ACOs.  These organizations join five Advance Payment ACOs announced earlier this year.  Like their Medicare Shared Savings Program colleagues, they represent communities across America, and are made up of a diverse group of healthcare providers, including independent practice associations that are owned and operated by physicians. 

The interest of these small, independent practices in the ACO model demonstrates that the desire to improve care and lower costs through improvement exists in small practices as well as large health systems.  These providers are committed to improving the health and health care of their patients over the long haul. 

Recently, CMS announced that organizations accepted to the Medicare Shared Savings Program for January, 2013 would also have the opportunity to apply for Advance Payment Model.  At CMS, we’re committed to an ACO program that supports a diverse set of ACOs, allowing groups ranging from health systems to physician-led organizations to partner with us.

Inspired by SHIP Conference

By Darren Hotton, Utah SHIP Director

I attended the 18th Annual State Health Insurance Program (SHIP) Directors’ Conference earlier this month, down in Atlanta, Georgia. It was great visiting again with my fellow SHIP directors, counselors, community partners, and CMS staff. I always look forward to learning new and innovative ways to grow my local SHIP program, and this year’s program didn’t disappoint. If you missed it, check out the presentation materials available online.

There were plenty of terrific breakout sessions, including ones on best practices in volunteer recruitment, using social media to grow your SHIP, and casework help with deaf and hard of hearing communities and clients with dementia. I can only speak for the sessions I attended, but I’m confident all the breakout sessions pushed the SHIP network to look at other avenues to help improve and enhance their programs.

The plenary sessions were also outstanding, giving us all plenty of food for thought. For example, Dr. Adrienne Mims gave a thought provoking talk on the importance of understanding older Americans’ health. It’s amazing how people with Medicare forget that more prescriptions aren’t always a good thing. Dr. Mims’ presentation reminded the SHIPs that we need to speak with people with Medicare about adverse drug effects. In another session, Kathy Greenlee explained how changes to the Administration on Aging fit with the new federal agency where she serves as administrator, the Administration for Community Living.

For me, one of the highlights each year is the SHIP recognitions. What a wonderful feeling it is for a local SHIP network to get praise from fellow SHIPs. There’s no greater reward than having peers recognize all our hard work over the past year.

I want to thank CMS and the conference planning committee for another great conference. I look forward to improving my program this year with the information I got.

2012 Train-the-Trainer Workshops begin next week

With a mild winter and warm spring past us, this year it’s hard to tell where one season ends and another begins. For those of us in CMS’ Division of Training, a sure sign that summer has arrived is a new round of National Medicare Train-the-Trainer Workshops!

Each year we host a series of two-and-a-half day, face-to-face training events in major cities across the country. Our goal is to share consistent, accurate, current and reliable information with partners who train others—”training the trainer”—so they’re best equipped to help people with Medicare make informed health care decisions.

Our Train-the-Trainer Workshop is a perfect opportunity to learn about changes to CMS programs you may have missed. If you’ve been to one of our workshops in past years, it’s a good chance for you to brush up on your training skills.

We try to keep our sessions lively, interesting and memorable with knowledge checks, exercises, and casework video scenarios. This year’s workshops include:

  • Information on key aspects of Medicare, Medicaid, CHIP, and related legislation
  • A half-day basic track if you want a refresher or if you’re new to Medicare
  • A Web learning resource session to help you find information
  • Plan Finder updates
  • Casework exercises
  • Medicare training modules and workbooks
  • Opportunities to network with CMS staff and other partners who share your commitment
  • A 2012 Resource Card—with the training modules, videos, job aids and more!

Learn more about the workshops and register by visiting our Train-the-Trainer Workshops Web page.  We hope to see you in a workshop this summer!

Encouraging Innovation to Fight Medicaid Fraud

By Julie Boughn 

The Centers for Medicare & Medicaid Services (CMS) is committed to fighting Medicaid fraud, which diverts funds from needed medical care for the most vulnerable Americans.  That’s why we’re announcing a challenge – the Provider Screening Innovator Challenge – to develop software tools that will help stop fraudsters from entering the Medicaid program under the pretense of serving patients.

The Provider Screening Innovator Challenge encourages private sector competition to develop new software that can screen potential Medicaid providers and keep bad actors from ever getting into the program.  Through a series of contests over the next 8 to 9 months, expert software developers will work to create software products, and the best ideas will be awarded prize money.   A total of $600,000 is available for prizes, funded by the Partnership Fund for Program Integrity Innovation, a program within the Office of Management and Budget.

The new software products will include enhanced screening data, such as the results of site visits, criminal background checks, and identity verification.  Fraudsters who try repeatedly to enter Medicaid by altering their applications with a slight change will also be blocked.  The software will also capture licensing information and financial data to spot and stop risky providers.

CMS is conducting this Challenge in partnership with the National Aeronautics and Space Administration, Harvard Business School, the State of Minnesota, and TopCoder (an online community of software engineers, computer scientists, and digital creators).

We eagerly await the ideas and products offered through the TopCoder community to help keep bad actors out of State Medicaid programs.  CMS will also be working with additional States to help us in finalizing software requirements as well as piloting the new software.

The first contest begins May 30th at 6:00 p.m. Eastern Time. Registration information is available at the Center of Excellence for Collaborative Innovation Challenge portal: http://community.topcoder.com/coeci/.

Further information about the Provider Screening Innovator Challenge is available at www.medicaid.gov.

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