Medicare: Looking Toward the Future

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Medicare Looking Toward the Future
Medicaid Health Plans of America Medicare Part
D The First 100 Days Washington, DC April 19,
2006 Georges C. Benjamin, MD, FACP Executive
Director

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Our Model of Health Delivery Is Experiencing
The Perfect Storm

• Quality
• Disparities
• Medical errors
• Costs
• Less cost sharing
• Exploding costs
• Access
• Rising un/underinsured
• Provider availability
• 20th Century infrastructure
• Clinical information
• Financial management
• Program management

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Population 65 Years of Age and Over 1950-2030
Number in millions
70
60
50
40
30
20
10
85 years and over
0
1950
1970
1990
2010
2030
SOURCE CDC/NCHS,
Health United States, 1999
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Race / Ethnic Composition US Population
Foreign born
Hispanic
Black
Other
Native born, non-Hispanic White
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Medicare As A Drum Major For Health Improvement

• Historically has often led insurance reform
• Can be used to provide solutions at national
  level to improve health
• Should be viewed as an economic engine

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National US Health Expenditures 2003

• Hospital Care 515,900,000,000
• Physician and Clinical Services
  369,700,000,000
• Dental Services 74,300,000,000
• Nursing Home Care
  110,800,000,000
• Home Care 40,000,000,000
• Prescription Drugs 179,200,000,000
• Admin/Net Cost of Insurance
  119,700,000,000
• Govt Public Health Activities
  53,800,000,000
• 1.6 trillion
• (Smith C et al, Health Affairs
  200524185-194)

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Chart III-2. U.S. Health Expenditures as Share of
GDP Expected to Rise Through Next Decade
Expenditures as percent of gross domestic product
(GDP)
Projected
Source Center for Medicare and Medicaid
Services, Office of the Actuary, 19982003 from
CMS Health Accounts data file nhegdp03.zip
available at http//www.cms.hhs.gov/statistics/nhe
/default.asp 20042014 published in Heffler et
al., "U.S. Health Spending Projections for
20042014," Health Affairs Web Exclusive
(February 23, 2005) W5-74W5-85.
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Policy Goals For Controlling Costs

• Must bring down costs of care for individuals
• Must decrease slope of health costs growth curve

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Medicare As A Quality Improver

• Data driven quality improvement
• Eliminating disparities
• Reducing medical errors

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Chart II-2. Provision of Appropriate Care Varies
by State
Performance on Medicare Quality Indicators,
20002001
Note State ranking based on 22 Medicare
performance measures.
Source S. F. Jencks, E. D. Huff, and T. Cuerdon,
"Change in the Quality of CareDelivered to
Medicare Beneficiaries, 19981999 to 20002001,"
Journal of theAmerican Medical Association 289
(Jan. 15, 2003) 305312.
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Chart II-1. U.S. Adults Receive Half of
Recommended Care, and Quality Varies
Significantly by Medical Condition
Percent of recommended care received
Source E. McGlynn et al., "The Quality of Health
Care Delivered to Adults in the United
States,"The New England Journal of Medicine
(June 26, 2003) 26352645.
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Treatment of Early Stage Lung Cancer Medicare
1985-1993
Bach et al, 1999
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Rate of Cardiac Intervention Among Medicare
Patients Hospitalized With An Acute Heart Attack
Ford et al, 2000
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The Healthcare Divide
Schneider et al., JAMA, March 13, 2002
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Chart II-5. Errors Compromise Quality of Care
Percent reporting any medical mistake, medication
error, or lab error in past two years
Among those with blood test, x-rays, or other
medical tests in the past two years. Source 2005
Commonwealth Fund International Health Policy
Survey of Sicker Adults.
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Chart II-3. U.S. Performs Relatively WellBut
Emphasis on Prevention is Still Lacking
Percent who DID NOT receive reminders for
preventive care
Source 2004 Commonwealth Fund International
Health Policy Survey.
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Ensuring Access To Care

• Ensuring provider access
• Access to prescription drugs
• 43 million eligible 15 million remain Many low
  income underserved minorities
• Full access to preventive services
• Adequate access to mental health services
• Medicare could be building block for universal
  coverage

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Chart II-11. Physician Use of Electronic
Technology Could Be Expanded
Percent indicating "routine/occasional" use
p lt .01, Cuzick's test for trend Base All
respondents (N1837)
Source Commonwealth Fund 2003 National Survey of
Physicians and Quality of Care.
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Using Technology

• Moving into the modern technological age is an
  imperative
• Medicare can drive this change
• Reduce administrative costs
• Improve quality
• Reduce errors

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Physician Report
GIS Software
Health Department
Database GEPI 96
Public Health Reporting
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Medicare Could Be Leader

• Patient education and testing
• Demand management triage
• Paperless Clinic
• Linking home health long term care
• Smart Health House N. C.
• Urinalysis, Medicine Cabinets, Scales
• Linkage to wearable Computers
• Nanoplastics, AI Expert Systems

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Chart IV-3. Health Policy Experts Suggest
Various Changes to Medicare
"Do you favor or oppose changing Medicare in the
following ways?" (Percent who favor)
Source Commonwealth Fund Health Care Opinion
Leaders Survey, July 2005.
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Recommendations for Part D

• Extend May 15th enrollment deadline
• 15 million at risk
• Primarily low income low disease burden
• Close the doughnut hole
• Remains a intellectual enigma
• Allow the program to negotiate for prescription
  drugs
• Best way to lower costs
• Enhance enrollee support systems
• Reduce uninsured for pharmacy
• Study potential costs of coverage lapses to
  program
• Identify costs that can be avoided preventable
  health problems
• Recycle savings into improve program

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• Georges C. Benjamin, MD, FACP
• Executive Director
• American Public Health Association
• WWW.APHA.ORG

Public Health Prevent, Protect, Promote