Primary Care Innovation: The Patient-Centered Medical Home

It is widely accepted that the U.S. health care system, although touted by some as the “best system in the world,” has room for improvement. Many people have no regular health care provider. Care is often fragmented and lacks coordination, which compromises quality and efficiency. Incentives for providers have not caught up with the demographics of chronic care. Some 75 percent of Medicare spending is on beneficiaries with five or more chronic conditions – and those people see an average of 14 different physicians a year.

Using Medicare as Part of Coverage Expansion?

A new proposal by The Commonwealth Fund suggests, as a major component of moving toward coverage for all, a Medicare-like program that uninsured adults below the age of 65 could purchase voluntarily. Reform proposals offered by Senators Clinton and Obama as part of their presidential campaigns feature similar options, as do some state reform plans.

Medicare Part D: What Now, What Next?

Close to 24 million Medicare beneficiaries enrolled in Part D coverage for prescription drugs in the first two enrollment cycles. According to the Centers for Medicare and Medicaid Services (CMS), more than 75 percent of beneficiaries are satisfied with the program. However, evidence suggests that seniors who were uncovered in 2005 benefited more than other enrollees in 2006. HHS has announced that more than 90 percent of Medicare beneficiaries in a stand-alone prescription drug plan will have access to at least one plan with a lower premium in 2008[1]; and the third open enrollment period is now upon us – November 15 through December 31, 2007.

Changing the Culture and Improving Quality: Innovations in Long-Term Care

Culture change in the long-term care world involves many players – residents, administrators, workers, lawmakers, policy analysts – sharing a common vision. One such vision attracting attention has been developed by a group of citizens, providers and advocates known as Pioneers who are exploring alternatives to traditional nursing facilities. Their goal: facilities that are resident-centered, less institutional and more home-like. This involves trying to piece together financing from Medicaid, Medicare and private funding sources.

Medicare Private Fee-for-Service Plans

Over the past three years, enrollment in Medicare private fee-for-service (PFFS) plans has increased significantly. These plans offer a potentially greater choice of providers than beneficiaries will find in Medicare HMOs or PPOs. They often provide extra benefits not found in traditional Medicare. Beneficiaries attracted to the plans hope to lower their out-of-pocket costs compared to what they would pay in traditional Medicare. However, the plans have drawn the interest of federal budget cutters since they cost more per beneficiary than traditional Medicare. Moreover, beneficiaries have been reporting confusion about the plans and sometimes, enrollment fraud. Some private fee-for-service beneficiaries have been denied services by physicians who previously accepted their traditional Medicare coverage. This toolkit, supported by the Robert Wood Johnson Foundation, contains resources that describe the basics of PFFS plans, advantages and incentives included in the plans, and the challenges that PFFS enrollees have encountered along the way.

Medicare 101: What You Really Need to Know

Medicare covers nearly 44 million beneficiaries who are elderly, including 37 million seniors and 7 million younger adults with permanent disabilities, and end stage renal disease. The program cost the federal government approximately $375 billion in 2006, accounting for 13 percent of federal spending. Why is Medicare important for congressional staffers to know about?

Prospects for Health Care: Where Will New Congressional Leadership Take Us?

Come January, we can expect to see some new approaches to health legislation. Sen. Harry Reid, incoming Senate majority leader, says one of his top three priorities will be more funding for stem cell research. House Speaker-to-be Nancy Pelosi wants a vote early on to roll back the prohibition against the federal government negotiating prescription drug prices for Medicare beneficiaries. And these are just two of the health issues likely to be debated in the new Congress. The White House too will have a definite voice in the debates to come.

Who Cares What Patients Think?

The growing complexity of our health care system, and time demands on providers, can cause patients’ non-obvious needs to get lost in the shuffle. Sometimes, the result can be less-than-optimal care. In response, providers are trying to be more responsive to patients’ cultural traditions, family situations, personal preferences and values. Some have tagged this movement “patient-centered care.”

Treatment of Severe Chronic Illness: What Explains Cost and Quality Variations? Should We Be Concerned?

Some Medicare beneficiaries receive significantly more hospital-based services during the last two years of life than do other beneficiaries. The number of physician visits for Medicare beneficiaries can also vary greatly. What accounts for this variation? Do patients receiving more services tend to get better care, or not? Should policymakers take steps to more closely examine the relationship between spending and the volume of services provided at different facilities?

Helping the Medicare Savings Programs Get Savings to Seniors

The Medicare Savings Programs provide assistance with premiums — and in some instances, cost sharing requirements — to Medicare beneficiaries of limited income and resources who do not qualify for full Medicaid benefits. Medicare Part B premiums currently amount to over $1,000 annually — which can be a large sum for some beneficiaries.

Medicare Advantage: Early Views and Trendspotting

Although it’s best known for introducing the Medicare prescription drug program, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 also made a number of changes to the Medicare managed care program – Medicare Advantage. Among the aims: Keep managed care plans from leaving the program by offering higher payments, and give beneficiaries more reasons to consider joining.

Making Sense of Medicare’s Drug Benefit: Information and Resources to Help Beneficiaries

Medicare now covers nearly 42 million beneficiaries who are elderly, or who have a severe disability or end stage renal disease. The Medicare Modernization Act of 2003 made many changes to the program – including the addition of an outpatient prescription drug benefit (“Part D”), which will become effective in January 2006. Understanding this new benefit is of paramount importance to the many people who advise senior citizens, and to millions of Medicare beneficaries who will be scrutinizing different prescription drug plans available in their area.

Implementing the Medicare Drug Benefit: The Stories Ahead

Medicare now covers nearly 42 million beneficiaries who are elderly, or who have a severe disability or end stage renal disease. The Medicare Modernization Act of 2003 made many changes to the program – including the addition of an outpatient prescription drug benefit (“Part D”), which will become effective in January 2006. Understanding this new benefit is of paramount importance to the many people who advise senior citizens, and to millions of Medicare beneficaries who will be scrutinizing different prescription drug plans available in their area.

Pay-for-Performance: Taking Health Care Quality Improvement to the Next Level

Pay-for-performance programs have been touted by some as a way to improve the overall quality of care provided to patients, while being criticized by others who fear unintended consequences in attempting to change physician behavior. The Medicare Payment Advisory Commission has recommended that pay-for-performance be incorporated into Medicare reimbursement policy in a number of areas. Recent laws, including the Medicare Modernization Act, have mandated pay-for-performance demonstration projects, including one for chronically ill Medicare patients.

Medicare Basics From (Part) A to D

Medicare covers nearly 42 million beneficiaries who are elderly, or have a disability or end stage renal disease. Spending on Medicare benefits accounted for 17 percent of the nation’s total health care spending in 2004. The Medicare Modernization Act of 2003 made many changes to the program including the addition of a prescription drug benefit (“Part D”), which will begin full implementation in 2006.

How Good is the Quality of Care in Medicare?

The federal government’s responsibility to provide access to health care for the nation’s 41 million Medicare beneficiaries implies another obligation: to spend taxpayer dollars wisely. This means assuring that the $250 billion+ spent for Medicare goes for services that are safe, timely and effective.

Checking Up: What Are Your Hospital’s Vital Stats?

A newly launched website known as “Hospital Compare” is the most comprehensive attempt yet by the Centers for Medicare and Medicaid Services (CMS) to display voluntary, self-reported information by hospitals on steps that can be taken to reduce the impact of three major causes of morbidity and mortality – heart attack, heart failure, and pneumonia – in a consumer-friendly format.