Medicare Open Enrollment – New Features make Shopping for 2018 Coverage Easier!

By Seema Verma, Administrator, Centers for Medicare & Medicaid Services (CMS)

Each October, as the days grow shorter, time seems to speed up. Maybe it’s because we start planning for the looming holidays or begin bracing for the cold winter, but before we know it we’re saying goodbye to one year and ringing in a new one. That’s why it’s important to set aside some time between now and early December to think about your 2018 healthcare needs by shopping for high-quality Medicare health and drug plans during Open Enrollment.

Medicare Open Enrollment kicked off on October 15 and will run through December 7. I’m pleased to share that you will have better access to high-quality health coverage choices offering more options and lower premiums in 2018. This means you should be able to find plans that cost less but still give you quality care and better customer service. In fact, the number of Medicare Advantage plans available to individuals across the country is increasing from about 2,700 to more than 3,100 – and more than 85 percent of people with Medicare will have access to 10 or more Medicare Advantage plans. We are estimating that the average Medicare Advantage monthly premium will decrease by $1.91 in 2018, from an average of $31.91 in 2017 to $30. The Medicare prescription drug plan average basic premium is projected to decline for the first time since 2012 (a decrease of approximately $1.20 below the 2017 average basic premium of $34.70).

The choices available demonstrate the benefits of supply and demand market forces in a strong healthcare market. Consumers are demanding more from their insurance plans and in turn Medicare Advantage and Part D plans, like any business, are responding with better service at a lower cost leading to a truly patient-centered approach to healthcare.

Medicare is making some exciting changes of our own to make it easier for you to make an informed choice between Original Medicare and Medicare Advantage. You may have noticed a few of these changes in your Medicare & You handbook, but it doesn’t stop there. We’re improving our digital features on Medicare.gov, where you can sign-up to get timely notices about Open Enrollment and other important Medicare updates directly to your inbox. While on Medicare.gov be sure to check out the new help wizard that will point you to resources that will help you make informed healthcare decisions. These updates mirror the private sector and reflect a few ways we’re modernizing the customer service experience.

If you’ve been thinking about starting your new year with a Medicare Advantage or Prescription Drug Plan, or you’re interested in making some changes to your current plan, now is the time to shop for your coverage. Medicare health and drug plans change each year, and so can your health needs. That’s why it’s always a good idea to consider what needs you may have for 2018 and take a look at the available plans in your area.

Your coverage will begin on January 1, 2018. If you miss the deadline, you will likely have to wait a full year before you are able to make changes to your plan. During Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you find your current coverage still meets your healthcare needs, then you’re done.

Open Enrollment is also a good opportunity to make sure you’re doing everything you can to protect your identity and your health by guarding your Medicare card like you would a credit card. Identity theft resulting from stolen Medicare numbers is becoming more and more common. Medicare is here to help in the fight by removing Social Security Numbers from Medicare cards and replacing them with a new, unique number for each person with Medicare. Medicare will mail new Medicare cards with the new numbers between April 2018 and April 2019.

Don’t let the opportunity to have better quality healthcare at a lower price pass you by. Get a jump start on your new year’s health resolution today. You can visit Medicare.gov (http://www.medicare.gov), call 1-800-MEDICARE, or contact your State Health Insurance Assistance Program (SHIP) to learn more.

Las Nuevas Tarjetas de Medicare Ya Llegarán Pronto

Por: Seema Verma, Administradora de los CMS

Como podría haber escuchado ya, o quizás ya vio un comercial de televisión, los Centros de Servicios de Medicare y Medicaid pronto emitirán a cada beneficiario de Medicare una nueva Tarjeta de Medicare, sin números de Seguro Social, para prevenir el fraude, mantener seguros los fondos de los contribuyentes, y para asegurar que siempre ponemos las necesidades de los pacientes primero.

Desafortunadamente los criminales están cada vez más interesados en las personas de 65 años o más para el robo de identidad médica, incluso cuando alguien usa ilegalmente el número de Medicare de otra persona. Un ladrón de identidad puede facturarle a Medicare por servicios costosos que nunca fueron proporcionados o cobrar más por los servicios proporcionados. Esto puede resultar en ambigüedades en los registros médicos, lo que puede significar el retraso en la atención o servicios negados para los pacientes y también impacta los fondos de los contribuyentes.

Para ayudar a combatir esto, les enviaremos a todos los beneficiarios de Medicare una nueva tarjeta con un número único asignado al azar. Cuenta con once caracteres, una combinación de números y letras mayúsculas.

Debido a que el número se genera al azar, no hay conexión a otra información de identificación personal. Este nuevo número reemplazará al número actual basado en el Seguro Social, y está diseñado para proteger la información personal de los beneficiarios de Medicare.

Comenzaremos a enviar por correo las recién diseñadas tarjetas de Medicare en abril de 2018, y reemplazaremos todas las tarjetas antes de abril de 2019. Si usted es beneficiario de Medicare o pronto lo será, no tendrá que hacer nada y podrá comenzar a usar su nueva tarjeta tan pronto como la reciba.

Cuando reciba su nueva tarjeta, le pediremos que destruya su tarjeta de Medicare de una manera segura. Asegúrese de traer la nueva tarjeta a las citas de sus médicos, y mantenga siempre confidencial su nuevo número. Esto ayudará a proteger su identidad personal y prevenir el fraude de identidad médica porque los ladrones de identidad no pueden facturar a Medicare sin un número de Medicare válido. Además, usted y sus proveedores de atención médica podrán utilizar herramientas seguras en línea que estamos desarrollando y que brindarán acceso rápido a su número de Medicare cuando sea necesario.

Usted va a escuchar mucho más acerca de esta iniciativa en las próximas semanas y meses, y también estamos ayudando a los médicos y otros proveedores de atención médica a prepararse para el cambio. Queremos hacer este proceso tan fácil como sea posible para todos los involucrados. Sobre todo, queremos que las personas con Medicare y los proveedores de atención médica sepan estos cambios con anticipación y tengan la información necesaria para asegurar una transición fácil a la nueva tarjeta.

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New Medicare Cards are Coming Soon

By:  Seema Verma, CMS Administrator

As you may have heard, or perhaps you’ve seen a recent TV commercial, the Centers for Medicare & Medicaid Services will soon be issuing every Medicare beneficiary a new Medicare Card, without Social Security Numbers, to prevent fraud, fight identity theft, and keep taxpayer dollars safe, and to help ensure that we always put the needs of patients first.

It’s unfortunate that criminals are increasingly targeting people age 65 or older for medical identity theft, including when someone illegally uses another person’s Medicare number. An identity thief may bill Medicare for expensive services that were never provided or overbill for provided services. This can lead to inaccuracies in medical records, which can mean delayed care or denied services for patients and impacts taxpayer funding.

To help combat this, we’ll be sending all Medicare beneficiaries a new card with a unique, randomly-assigned Medicare number.  It will consist of eleven characters, a combination of numbers and uppercase letters.

Because it is randomly generated, there is no connection to any other personal identifying information. This new number will replace the Social Security-based number currently used on all Medicare cards, and it’s designed to protect the personal information of Medicare beneficiaries.

We’ll begin mailing the newly designed Medicare cards in April 2018, and we’ll replace all cards by April 2019. If you’re a Medicare beneficiary, or soon will be, you don’t need to do anything, and you can start using your new card as soon as you get it.

When you get your new card, we’ll ask you to safely and securely destroy your current Medicare card.  Make sure you bring the new card to your doctors’ appointments, and always keep your new number confidential.  This will help protect your personal identity and prevent medical identity fraud because identity thieves can’t bill Medicare without a valid Medicare number. Additionally, you and your health care providers will be able to use secure online tools that we’re developing that will support quick access to your Medicare number when needed.

You’ll be hearing a lot more about this initiative in the coming weeks and months, and we’re also helping doctors and other healthcare providers get ready for the change.  We want to make this process as easy as possible for everyone involved. Above all, we want to ensure that people with Medicare and healthcare providers know about these changes well in advance and have the information needed to ensure an easy transition to the new card.

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The true strength of our healthcare system is its people

By Seema Verma, Administrator for the Centers for Medicare & Medicaid Services

As a wife and mother, my family’s health is always foremost on my mind. That is why a recent personal experience will forever shape the impact I want to have while serving as Administrator of the Centers for Medicare and Medicaid Services.

Earlier this month, while at an airport with our two children, my husband collapsed and went into cardiac arrest. He’s home now and his prognosis is excellent. However, if it weren’t for the courageous bystanders who administered CPR and the dedicated medical professionals at the Hospital of the University of Pennsylvania where he was admitted, he wouldn’t be with us today.

I wasn’t at the airport when my husband collapsed. I arrived at the hospital as soon as I could, and as I met the team of professionals who were caring for him, I was amazed by their skill and compassion. From the hospital administrators to the physicians, nurses, and many others who took charge of his care, I witnessed the true greatness of our healthcare system: the remarkable people who serve within it.

My life would be very different if it weren’t for the diligence and expertise of the first responders at the airport and the healthcare professionals at the hospital. Even in our age of advanced technology, procedures, and therapies, it’s the people that make our healthcare system one that we feel we can entrust with the care of our loved ones.

My husband is a physician, and I have many relatives and close friends who are healthcare professionals as well.  To a person these caregivers are some of the smartest and most selfless people I know. They have put in long hours and made many sacrifices along the path of medical education and training. What motivates them isn’t a promise of high salaries, or a quest for esteem, but a genuine drive to help patients and their families when they are most vulnerable.

Our healthcare system is made up of a community of professionals who want to do good.  As a wife and a mother I am so grateful for this, because these professionals saved my husband and my children’s father. As the Administrator of CMS, I am inspired by this and feel compelled to do everything I can to support these caregivers. Our agency must make it easier for them to focus on doing the work that patients and families need them to do without causing them to be subject to excessive regulatory and administrative burden.

That’s why in all of our recent proposed rules, CMS has asked healthcare providers for their thoughts on how to simplify our regulations. And over the next few months we will be announcing additional initiatives to ease the burden our government places on healthcare providers. We will continue to engage with our providers on their concerns.

Some regulations are necessary in order to ensure patient safety and well-being, and to protect the integrity of federal health care programs.  However, over the past few years, regulations have tilted more towards creating burdens than towards serving as a safeguard for the programs.  This shift is now having a negative impact on patient care, hindering innovation, and increasing healthcare costs.

To make sure we are addressing the actual pain points that doctors feel, we are visiting them where they work, listening to their stories about the challenges they face, and bringing those lessons back to CMS. We have heard time and again that documentation for payment and for quality reporting is unnecessarily time-consuming and keeps clinicians working late into the night just to keep up on paperwork. Electronic health records that were supposed to make providers’ lives easier by freeing up more time to spend on patient care have distanced them from their patients. New payment structures that were meant to increase coordination have added yet another layer of rules and requirements.

No one went into medicine to become a paperwork expert. We are listening, integrating the feedback we hear into our work at CMS, and making changes that will make it easier for doctors, nurses, and other clinicians to do what they entered medicine to do: take care of those in need.

It can be easy to forget how important our healthcare system is, to forget that every day, men and women are hard at work treating, comforting, and healing. For those of us whose families have received lifesaving care, we are forever grateful. The entire CMS team and I are committed to doing our part to make sure that these caring professionals can do their job without the burden of unnecessary regulation.

National Minority Health Month: Bridging Observance and Action to Achieve Health Equity

By Cara V. James, PhD, Director, CMS Office of Minority Health 

Each April we observe National Minority Health Month. This year’s theme is, Bridging Health Equity Across Communities. This theme acknowledges the important role that social determinants of health play in individual and community well-being. It also evokes action and activity  around health equity. For it is not enough for us to simply observe National Minority Health Month and share statistics on long-standing health and health care disparities. We should strive to move the needle by reducing these disparities and improving health care quality and outcomes for all. As this National Minority Health Month comes to a close, we still have work to do, and I’m hoping each of us can take a moment and consider the following question:

What will it take to achieve health equity?

CMS has adopted a health equity framework that focuses on increasing understanding and awareness of disparities, developing and disseminating solutions, and implementing sustainable action. As we have sought to implement this framework, we have identified a number of areas that need to be considered when addressing a specific disparity– the social determinants of health, data, and the seven “A’s”.
First and foremost, we need to acknowledge there is a problem to be addressed. We need to agree on the goal and identify what resources will be necessary to meet it. Resources can be difficult to come by, so determining how the goal aligns with existing priorities may be key. Next we must decide what actions do we need to take to achieve our goal? Are we already doing some or all of them?

Seven A’s for Addressing Health Equity

  1. Acknowledge there is a problem to be addressed.
  2. Agree on the goal, and identify what resources are necessary to meet it.
  3. Align the goal with existing priorities.
  4. Determine what actions are needed to achieve the goal.
  5. Create alliances to implement the actions.
  6. Analyze progress, and adjust the plan as necessary.
  7. Have shared accountability for reaching the goal.

 

We know that health equity cannot be achieved by a single individual or organization, so forging alliances and working together is critical. We also know that we must be able to measure our progress. Having data and doing analysis of it are important for the development, assessment, and revision of our health equity plan. The last of the A’s requires us to be accountable and ask the question – what happens if we do not reach our goal? There shouldn’t be one person or organization responsible for the success or failure of a plan, but a shared accountability.

While we are considering each of the seven A’s, we must also consider the myriad of social factors that influence health and well-being of individuals and the communities in which they reside. Whether we refer to them as social risk factors or social determinants of health, we know that things such as socioeconomic position, race, ethnicity, cultural context, gender, social relationships, and residential and community context affect our health more than the care we receive from our health care providers. We must consider these factors as we think about our goals, the actions we need to take, and the alliances we forge.

The CMS Office of Minority Health is helping to embed these actions across CMS and HHS. For example, we routinely share HEDIS and CAHPS quality measures stratified by race, ethnicity, and gender, providing health plans with actionable data to innovate and prioritize health equity and quality improvement activities. Organizations participating in the Accountable Health Communities Model will be montoring disparities as they link beneficiaries with commmunity services. We are working with our sister agency, the Health Resources and Services Administration’s, Federal Office of Rural Health Policy on a Chronic Care Management Education and Outreach Campaign. The campaign is focused on professionals and consumers in underserved rural areas, and racial and ethnic minorities. We are also collaborating with organizations outside the federal government to help reduce readmissions among racially and ethnically diverse beneficiaries, and to develop their own plans for achieving health equity.

As we continue on our path to equity, we encourage you to consider the seven A’s, the role of social risk factors, and the importance of data in your day-to-day activities. Recommit every day to the ultimate goal of achieving health equity by bridging observance and action during the remainder of National Minority Health Month and throughout the year.

To learn more about achieving health equity and other activities underway at the CMS Office of Minority Health, visit: go.cms.gov/omh. 

CMS’ Ongoing Commitment to Minority Health

April 26, 2017

By: Seema Verma, Administrator, Centers for Medicare & Medicaid Services (CMS)

As many of you know, April is National Minority Health Month, and it’s a privilege to be Administrator at the Centers for Medicare & Medicaid Services (CMS) and take part in the observance. This year’s theme is “Bridging Health Equity Across Communities”. At CMS we have an extraordinary opportunity to improve health outcomes for the over 100 million people that we serve every day. Our primary mission is to make healthcare accessible and affordable for all Americans.

During this important month, we continue our efforts to raise awareness about disparities, and provide tools and resources to support actions to address them. In addition to our ongoing work to address these disparities through efforts like the CMS Equity Plan for Improving Quality in Medicare, the CMS Office of Minority Health released new Medicare Advantage (MA) data on racial and ethnic disparities in care. The data helps us understand the connections between a person’s race, ethnicity, and gender and the health care that they receive.

Two new reports focus on the treatment and patient care experiences for a variety of conditions. The first report looks at racial and ethnic disparities by gender and examines differences between black, Hispanic, Asian and Pacific Islander and white MA beneficiaries in rates of colorectal cancer screening, treatment for chronic lung disease and other conditions as well as their ability to access needed care.

The second report looks at gender differences in access to care and quality of treatment for certain conditions among MA beneficiaries. It shows that women receive better treatment for chronic lung disease and rheumatoid arthritis and are more likely than men to receive proper follow-up care after being hospitalized for a mental health disorder.

This tremendous research can only point out the problems. We need healthcare professionals, stakeholder organizations, researchers, and community groups to use these CMS reports, along with our other tools and resources, to develop interventions for racially and ethnically diverse Medicare beneficiaries. 

Through transparency, flexibility, and innovation, we will use every available tool to improve the Medicare program and promote the availability of high value and efficiently-provided care for all beneficiaries. We do this, by working together with plans, providers and the patients we serve to find ways to reduce the disparities highlighted in these reports and find effective health solutions that work for all communities and all Americans.

 

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Supporting Comprehensive and Innovative Care for Children: Request for Information on a Potential Pediatric Alternative Payment Model

February 27, 2017

By Patrick Conway, M.D., M.Sc., Acting Administrator, Centers for Medicare & Medicaid Services; Deidre Gifford, M.D., M.P.H., Deputy Director, Center for Medicaid and CHIP Services; Ellen-Marie Whelan, N.P., Ph.D., Chief Population Health Officer, Center for Medicaid and CHIP Services; and Alex Billioux, M.D., D.Phil., Director, Division of Population Health Incentives and Infrastructure, Center for Medicare & Medicaid Innovation

In partnership with states and providers, the Centers for Medicare & Medicaid Services (CMS) plays a leading role in safeguarding the health of America’s future by providing coverage for more than one in three American children[1]. Through Medicaid and the Children’s Health Insurance Program’s (CHIP) mandatory and optional benefits, children receive access to a spectrum of comprehensive and preventive health care services aimed at providing a sound start for lifelong health. As a result, children enrolled in Medicaid and CHIP lead the nation in participation in preventive care and access to needed care[2].

CMS and states have also demonstrated consistent commitment to improving the health of children through care redesign and innovation in programs such as Medicaid Health Homes, the Medicaid Innovation Accelerator Program, and models tested under the Center for Medicare and Medicaid Innovation (Innovation Center), including the State Innovation Models Initiative and Strong Start for Mothers and Newborns Initiative. To build on those efforts, the Innovation Center, in partnership with the Center for Medicaid and Chip Services (CMCS), is releasing a Request for Information (RFI) today seeking input on the design of alternative payment models focused on improving the health of children and youth covered by Medicaid and CHIP. As the insurer of a third of the nation’s children and a leader in health care innovation, CMS is uniquely positioned to improve the health of America’s children.

We know there is more to health than health care alone, and for children, factors such as sound nutrition, safe living environments, responsive adult caregivers, and nurturing social relationships are especially critical for healthy growth and development. Inadequate or inconsistent access to these factors can have physical and behavioral impacts that reverberate throughout a child’s life course as he or she grows into adulthood. Some children and youth enrolled in Medicaid and CHIP, especially those that are high-need and high-risk, may experience barriers to accessing the optimal combination of child-focused programs and services that are available to address these critical factors. Through the RFI, we are seeking input on approaches to improve the quality and reduce the cost of care for children and youth enrolled in Medicaid and CHIP. In particular, we are exploring concepts that encourage pediatric providers to collaborate with health-related social service providers (e.g., early childhood development programs, child welfare services, and home and community based service providers) at the state and local levels and share accountability for health outcomes for children and youth enrolled in Medicaid and CHIP.

CMS seeks input through the RFI from the broad community of child and youth-focused stakeholders on concepts critical to addressing the comprehensive health needs of children and youth, such as:

  • Opportunities and impediments to extending and enhancing integrated service model concepts like accountable care organizations (ACOs) to the pediatric population;
  • Flexibilities and supports states and providers may need in order to offer such models of care to a state’s pediatric population; and
  • Approaches for states and providers to coordinate Medicaid and CHIP benefits and waivers with other health-related social services for children and youth.

Investing in child health can provide lifelong benefits and improve the nation’s health. We look forward to front-end comments from our state partners and other stakeholders who share our dedication to improving the health of our nation’s children.

For more information on the RFI, please visit: https://innovation.cms.gov/initiatives/pediatric-apm. To be assured consideration, RFI comments must be received by April 7, 2017.

[1] Department of Health and Human Services. 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP. February, 2016. https://www.medicaid.gov/medicaid/quality-of-care/downloads/2015-child-sec-rept.pdf

[2] See CHIPRA Mandated Evaluation of the Children’s Health Insurance Program: Final Findings, available at

http://www.mathematica-mpr.com/~/media/publications/pdfs/health/rpt_chipevaluation.pdf; Kreider AR, French B, Aysola J, Saloner B, Noonan KG, Rubin DM. Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families. JAMA Pediatr. 2016;170(1):43-51. doi:10.1001/jamapediatrics.2015.3028

 

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