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Medicare News
Medicare to Expand Efforts to Get Senior Citizens to
Manage Their Health
Seeks proposals on risk
reduction project aimed at chronic disease
 August 22, 2006 – Somewhat frustrated by senior
citizens not taking full advantage of the preventive services offered by
Medicare and concerned about costly chronic diseases, the government has
announced it is seeking up to five organizations to participate in a health
promotion and disease prevention program. The program will also involved
85,000 Medicare fee-for-service beneficiaries as volunteers.
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The demonstration announced yesterday will address
multiple health risk factors that contribute to chronic diseases,
including physical inactivity, obesity, smoking, depression, high blood
pressure, high cholesterol, high blood sugar, and underused Medicare
preventive benefits.
Taking a comprehensive approach to disease
prevention and management has been shown to be cost effective in
corporate settings, says the Centers for Medicare and Medicaid Services.
This demonstration project will be part of the CMS
Medicare Senior Risk Reduction Demonstration.
The demonstration will determine whether health
risk reduction programs that have been developed, tested, and shown to
be effective in the private sector can be tailored to the Medicare
program to help beneficiaries improve their health and thus reduce the
need for health care services.
“Personal involvement and personal choices have a
huge impact on health and health care,” said Mark B. McClellan,
administrator. of CMS, the agency that oversees the Medicare program.
“The Senior Risk Reduction Demonstration will help
us determine whether more intensive support can help our beneficiaries
stay well and prevent complications from chronic diseases.”
As part of the MyHealth, MyMedicare initiative, CMS
is working to help seniors improve their health by providing them with
the information, resources, and support they need to make lifestyle
changes and to get important preventive services.
Eighty-two percent of seniors have one chronic
condition, and about 50 percent have two or more. Seniors with these
conditions have better outcomes with fewer costly complications when
they are diagnosed early, and when they take lifestyle steps that are
proven to improve their health.
However, despite Medicare coverage, seniors are not
taking advantage of preventive services and important screenings that
can help detect diseases early.
For example, Medicare data from 1998 through 2002
indicate that only about 45% of eligible beneficiaries had one claim for
colorectal cancer screening during this five-year period, even though
colorectal cancer is the second leading cause of cancer death in the
U.S. and curable when detected early.
In the last two years, Medicare has added a variety
of new preventive benefits to help seniors take better care of
themselves. These include the "Welcome to Medicare" exam, which
provides education and counseling about important preventive services,
including screening tests and shots, and referrals for other needed
services for all new Medicare enrollees within their first six months of
starting their Medicare Part B coverage.
Other preventive benefits include cardiovascular
screening blood tests, diabetes screening, counseling to quit smoking,
and glaucoma screening for Hispanic Americans age 65 or over.
However, millions of seniors have chronic
conditions and do not know it, and are not treating them effectively,
because they are not taking advantage of Medicare’s new preventive
coverage.
For example, approximately one in five Medicare
beneficiaries have diabetes, but one-third of Medicare beneficiaries
with diabetes do not even know they have this disease. Medicare covers
diabetes self-management training, but many beneficiaries with this
disease have not taken advantage of this benefit.
Similarly, about 10% of seniors report that they
smoke, but very few have taken advantage of Medicare coverage for
smoking cessation counseling.
“We have made a commitment to modernize Medicare
and increase prevention efforts to reduce the burden of chronic
conditions, but we can only achieve this goal through a partnership with
seniors,” Dr. McClellan said.
“Our goal is to improve health and lower health
care costs by helping older Americans take steps to reduce their risk
factors and take advantage of Medicare’s improved preventive coverage.”
“This is one more step toward paying for what we
want: more disease prevention and better care leading to lower health
care costs,” added Dr. McClellan.
“This demonstration can support doctors and other
health professionals by providing support in their efforts to help
seniors make important changes, such as starting an exercise program and
using recommended preventive care.”
CMS will select up to five existing health
promotion, disease prevention, and risk reduction organizations to
participate in this three-year demonstration. Final award decisions
should be made by spring 2007.
Approximately 85,000 Medicare fee-for-service
beneficiaries will be invited to participate in the demonstration. After
completing a health risk assessment, participants will receive
information tailored to their particular health risk factors, as well as
referrals to community resources to help support them in making
lifestyle changes.
Information and support will be provided on an
ongoing basis using the beneficiary’s preferred communication method,
either through the mail, telephone, or internet. Beneficiaries will also
have the option of having information shared directly with their
physicians
The solicitation, which went on display yesterday
at the Office of the Federal Register, and additional information
concerning the demonstration can be found on the CMS website at:
http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/Senior_Risk_Reduction_Solicitation.pdf
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