16 Ways Medicare Is Using Innovation to Empower Seniors
Millions of Americans rely on Medicare for their healthcare and prescription drug needs. If you are among these millions, you understand how vital Medicare is for your healthcare.
The Centers for Medicare & Medicaid Services (CMS) has implemented 16 strategic initiatives to transform the healthcare system to deliver better value and results for you, the Medicare patient.
These 16 initiatives were developed with you in mind in hopes of providing better quality care along with making the process easy to use and understand.
We will take a look at the highlights for each of these initiatives and see how they will affect you and your coverage.
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Medicare's 16 Strategic Initiatives
1. Strengthening Medicare
This first initiative focuses on modernizing Medicare for its current recipients and future enrollees.
New technology tools have been added so you can shop for your healthcare needs. These tools include the following:
Each of these tools is designed to empower you as a consumer by enabling you to shop for your specific needs, compare prices, and understand what you can expect to pay for your benefits.
Sometimes, getting to the doctor is a significant feat, especially if you are nonambulatory, don't feel well, or have to rely on someone else to get you to an appointment.
A new feature that Medicare is now paying for is virtual check-ins, which allows you to connect with physicians by telephone or video chat. Virtual registration is an excellent thing for you to take advantage of for minor illnesses, follow-up appointments, or anything that can be taken care of without a doctor having to look at you in person. Just think of the time and effort you'll save with this new feature!
Also, a 2019 rule was imposed to help reduce your copayments. This rule promises to advance site-neutral payments for certain clinic visits provided in hospital outpatient departments to an amount that's comparable to a doctor's office visit across the physician office, Ambulatory Surgical Center, and hospital outpatient department settings.
2. Transforming Medicaid
This initiative was designed to provide states with greater flexibility to serve their residents and to promote stronger accountability for outcomes and program integrity for public dollars.
Balancing a state and federal partnership has been an essential step for Medicaid and is a result of the following actions:
- The support of state proposals to incentivize work and community engagement among non-elderly, non-pregnant adults who are not eligible for Medicaid based on disability
- Recognizing the urgency of the opioid crisis and providing treatment services
- Creating and publishing the first-ever CMS Medicaid and CHIP Scorecard to bring greater transparency and accountability to program outcomes
- Improving the processing times for Medicaid SPAs, 1115 demonstrations, and 1915 waivers
3. Marketplace Choice & Affordability
While this initiative doesn’t affect people on Medicare, the focus is to create an affordable, stable, consumer-directed individual health insurance market so that all Americans have access to quality healthcare at the lowest possible cost.
Individual states now have the freedom to develop and try out new ideas that can serve as a national model if proven successful.
Through this initiative, states have been granted the flexibility they need to create innovative solutions that will stabilize their markets, improve their risk pools, and provide more affordable coverage to you at the lowest possible cost.
These steps have been successful in stabilizing the market by offering more health care options, and in many cases lowering premiums for you, the consumer.
4. Protecting Taxpayer Dollars
The main focus of this initiative is to protect you against waste, fraud, and abuse within the healthcare system by utilizing cutting-edge strategies such as artificial intelligence, strategic audits, and systematic claims reviews.
Also, ensuring that the right payments are made at the right time to the proper beneficiary for covered, reasonable, and medically necessary services will help reduce the risk of mismanagement of your healthcare dollars.
5. Ensuring Safety and Quality
Ensuring that you are able to make decisions about your health care based on quality and cost information, this initiative focuses on safe and effective care, giving your doctor more time to spend with you.
The promise of more exceptional care and more time with your physician is provided through the following steps:
- Strengthening Oversight
- Enhancing Enforcement
- Increasing Transparency
- Improving Quality
- Putting Patients over Paperwork
Further reading: The 7 Most Common Scams and Frauds of 2019 That Seniors Should Know About
6. Innovating Payment Models
These Innovative Payment Models are designed to offer clinicians options that are set up to reward them for doing the job they were trained to do – spending time caring for you, the patient.
New payment models can be used to test new opportunities for providers to accept higher levels of risk and new financial arrangements that ease providers into value-based agreements.
While testing these models in areas of cost, outcomes, payments, and deliveries, specific requirements can be waived to give providers, clinicians, plans, and states more flexibility to focus on modernization, quality, and patient needs.
This area of testing payment models is proving to be very useful in providing quality care with optimal patient outcomes.
7. My Health EData
My Health EData ensures free access to your health information in a format that is practical, usable, and easily shared. You are in control of your digital and personal health data, therefore you can make smart healthcare decisions.
You will be able to electronically and securely share your health information with any provider, application, or researcher in an open, standards-based format that is commonly accepted and used across the healthcare system while also ensuring privacy.
This data sharing is vital for the following reasons:
- Increases patient safety
- Reduces duplicate tests
- Reduces conflicting medications
- Improves quality
- Reduces costs
- Ensures access to patient information
Blue Button 2.0, an eData tool, has been created to give you the ability to connect your data to 30 apps and other devices securely. Through this application, you can manage and improve your health care by accessing your Medicare records, tracking appointments, and creating reminders.
Blue Button makes it a priority to keep your information safe and secure, so there is no need to worry about your privacy when accessing this tool.
Read More: Getting Started With MyMedicare.gov: Medicare's Free Online Portal
8. Patients Over Paperwork
Following President Trump's Executive Order that directs federal agencies to cut the red tape, this initiative has made it possible for doctors and non-physician practitioners to focus on you, the patient, instead of paperwork.
By cutting the red tape, clinicians, providers and suppliers, administrators, and support staff have the freedom to remove barriers and eliminate overly-burdensome and unnecessary regulations to focus on the needs of their patients.
Aside from freeing up millions of hours for doctors to spend with their patients rather than on clerical duties, Patients Over Paperwork is saving the healthcare system billions of dollars.
9. Rethinking Rural Health
Often, senior citizens who live in rural America do not have access to the same quality of healthcare as those who live in more populated areas. The Rethinking Rural Health initiative provides these rural-dwelling Americans access to high quality, affordable healthcare through new and creative ideas.
Measurable steps have been taken to expand the availability of telecommunications-based services, change program requirements to achieve lower costs for drugs, promote flexibility in care delivery, and to provide patients in rural communities with access to quality, affordable health care.
10. Price Transparency
As a Medicare patient, you deserve to know the price of services upfront so you can make educated health decisions. The Price Transparency initiative was put in place to guarantee you that right.
When you have the information you need, you'll be able to make decisions based on cost and quality, which will make the healthcare system evolve into one that competes for your business.
As a result of this Price Transparency initiative:
- Pharmaceutical companies are required to disclose the list price of drugs in direct-to-consumer ads
- Each Part D plan must adopt a real-time prescription benefit tool of its choosing by 2021
- Hospitals are required to make their standard charge information available in a machine-readable format
- A "Procedure Price Lookup" is available that allows consumers to compare Medicare payments and copayments for specific procedures that take place in both hospital outpatient departments and ambulatory surgical centers
With price transparency, consumers can see the whole picture, allowing them to seek out high-value care among providers competing on both cost and quality.
Related reading: How Much Will Medicare Cost Me Per Month?
11. Better Care for Dual Eligibles
Americans eligible for both Medicare and Medicaid are some of our most vulnerable citizens. The Better Care for Dual Eligibles initiative ensures these individuals are receiving high-quality care to meet their needs.
The goal of this initiative is to improve quality, reduce costs, and improve the customer experience for those eligible for both Medicare and Medicaid by focusing on the following:
- Addressing complex needs
- Modernizing programs
- Aligning incentives
- Encouraging and unleashing innovation through the private sector
Serving these dual-eligible Americans in an affordable and attainable manner is being addressed through the Better Care for Dual Eligibles initiative, modernizing the Medicare Savings Programs (MSPs) by fixing the longstanding data problems that make it difficult to coordinate services.
Senior citizens are beginning to use technology more and more, and the eMedicare initiative is intended to provide a seamless online healthcare customer experience to meet the growing expectations and needs of these tech-savvy Medicare beneficiaries.
eMedicare is an state-of-the-art, multi-year initiative designed to update resources that provide you the opportunity to use technology to access current and personalized information, price, and quality information about coverage, as well as information to help you understand your Medicare benefits.
Since launching the eMedicare initiative in 2017, some accomplishments that have been successful include:
- What's Covered smartphone app
- Updated Plan Finder tool
- New web chat option in the Plan Finder tool
- Updated Medicare home page
Even though eMedicare focuses on the use of technology to help you access your Medicare information, you'll still have access to existing resources such as the 1- 800 toll-free line and paper copies of the Medicare & You handbook and the Medicare Summary Notice.
13. Fighting the Opioid Crisis
This Opioid Strategy focuses on three key areas for patients to garner the information they need to make the best health care decisions for themselves and their families through:
- Prevention: preventing and reducing opioid use disorder (OUD) by promoting safe opioid prescribing and encouraging non-opioid pain treatments
- Treatment: increasing access to evidence-based medicine for OUD
- Data: utilizing data to target prevention and treatment efforts to support fraud, waste, and abuse detection.
Fighting the Opioid Crisis initiative believes that prevention and treatment efforts addressing misuse, overuse, and over-prescribing of opioids will help reduce hospitalizations, emergency room visits, and family crises associated with the epidemic.
14. Modernizing CMS
This initiative focuses on transforming how CMS currently operates. Becoming more efficient and effective in promoting integration, encouraging collaboration among its staff, and supporting more active engagement with their stakeholders are essential steps towards building a positive environment for CMS workers.
Providing a positive working environment, creating a structure that better integrates, specializes, and improves the collaboration of their workforce across all 10 regions and the Central Office, and upgrading or developing their management teams will enhance the initiative program.
15. Fostering Innovation
Fostering Innovation ensures Medicare participants will have access to the latest medical technologies by removing barriers across the entire healthcare system.
Having access to the latest medical advancements, and removing barriers to these innovations, ensures you'll have access to these medical technologies which enables you to make the best healthcare decisions possible.
16. Lowering Drug Prices
Medicare and Medicaid represent 40 percent of the U.S. prescription drug market – the largest purchaser of prescription drugs in the world. Lowering Drug Prices initiative is working to lower prescription drug prices for all Americans through:
- Stronger competition
- Better negotiation
- Incentives for lower prices
- Increased transparency
This initiative entitles Medicare Advantage and Part D plans to negotiate lower costs and put forth the bold International Pricing Index (IPI) model to fix the troublesome incentives in Medicare Part B, get a better deal for American seniors, and bring Medicare drug payments in line with what other countries pay.
Do the 16 Strategic Initiatives Empower Medicare's Seniors?
These 16 initiatives are all put in place to give you, the Medicare participant, power!
From implementing technology to lowering prescription drug prices, to pricing transparency, to fighting the opioid epidemic, all the way to putting patients over paperwork, these 16 initiatives were all created with you in mind.
While each of these initiatives stands on their merit, they overlap and support each other as well. As you read through the initiatives, there are two underlying trends that flow through each one: Innovation and Empowerment.
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