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CMS Aims to Address Senior Poverty, Social Determinants of Health

CMS is working with partners and technology developers to address the social determinants of health for seniors, including poverty and care access.

CMS aims to address poverty, social determinants of health

Source: Thinkstock

By Jessica Kent

- To drive down healthcare costs for Medicare beneficiaries, CMS is expanding policies to reduce prescription drug prices, increase community partnerships, and foster technological innovations that will address poverty and other social determinants of health among the elderly.

These advancements are necessary, as older adults often face significant poverty challenges, said Cara V. James, Director of the CMS Office of Minority Health, and Tim Englehardt, Director of the Federal Coordinated Health Care Office, in a recent blog post.

“Poverty impacts millions of older Americans,” the pair wrote.

“One in four Medicare beneficiaries has less than $15,000 in total savings, and almost one in 12 has no savings or is in debt. There remain wide disparities among racial and ethnic groups: median per capita savings among white Medicare beneficiaries is more than six times greater than among either black or Hispanic beneficiaries.”

James and Englehardt noted that even with Medicare coverage, beneficiaries still struggle with high out-of-pocket costs. Among beneficiaries with incomes below the federal poverty level, 38.7 percent spend more than one-fifth of their annual incomes on premiums and out-of-pocket medical expenses.

READ MORE: Social Determinants of Health Impact Severity of Chronic Disease

To ensure beneficiaries are protected from sky-high out-of-pocket costs, CMS is working to increase price transparency for prescription drugs. In November 2018, CMS expanded policies that help beneficiaries save on prescription drugs administered in certain hospitals.

Additionally, CMS recently proposed policies that would ensure Medicare Part D and Medicare Advantage plans have tools to negotiate lower drug prices, which will also help lower out-of-pocket costs.

The organization also recently asked for public comment on an innovative drug pricing model, which would reduce Medicare spending for physician-administered drugs in Part B, as well as improve care quality.

The agency is focusing on initiatives that will address non-clinical factors as well.

“Recognizing the need for local innovation and the interconnectedness of health and social services, we are working on integrating services and addressing social determinants through Innovation Center models,” James and Englehardt said.  

READ MORE: Social Determinants of Health, Value-Based Care Key for Medicaid Success

One such model, the Accountable Health Communities Model, aims to promote clinical-community collaboration by screening beneficiaries to identify unmet health-related social needs. Over a five-year period, the model will provide support to community organizations that link beneficiaries with services that address the social determinants of health.

CMS is also collaborating with community organizations to promote existing programming that can help reduce the high costs of care.

“States, advocates, and community organizations can also help connect low-income Medicare beneficiaries with programs that help with Medicare premiums and cost sharing: the Medicare Savings Programs and Extra Help,” the authors said.

“Most of the state-based Medicare Savings Programs can save beneficiaries over $1,600 a year just by covering Medicare Part B premiums – money beneficiaries can use for food, housing, or other necessities.”

James and Englehardt noted that while millions of Americans qualify for Medicare Savings Programs, many are not yet enrolled.

READ MORE: PCPs Lack Time, Tools to Address Social Determinants of Health

States can take steps to simplify the enrollment process for beneficiaries, including simplifying the collection of data from beneficiaries, as well as providing adequate assistance to those enrolling in one of these programs.

CMS is also enabling beneficiaries to access affordable care in new, innovative ways.

“In Medicare – as with other forms of coverage – individuals can reduce their risk of high out-of-pocket costs by accessing free preventive services and actively shopping for the best value among Medicare’s options for health plans and drug coverage,” the authors said.

“CMS is focused on consumer empowerment and has created a suite of tools through the eMedicare initiative that we believe can assist cost-conscious senior as they seek out high value care.”

The recently launched “What’s Covered” app, part of the eMedicare initiative, allows beneficiaries, caregivers, and others to quickly see whether medical services and items are covered under Medicare. Consumers can use their mobile devices to get accurate, consistent information about services offered in doctors’ offices, hospitals, and other healthcare settings.

With these advancements, CMS is aiming to lower healthcare costs for Medicare beneficiaries while also improving care quality.

“Through innovation, partnership and a strong focus on making health care more affordable, we have the tools to further reduce senior poverty across the country,” James and Englehardt concluded.

“States interested in promoting access to programs or learning more about how to streamline administrative processes for the Medicare Savings Programs should contact their CMS Regional Office. States can also encourage beneficiaries to contact their local State Health Insurance Assistance Program (SHIP) or visit the Medicare Savings Programs and Extra Help CMS webpages.”


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