Building On The CMS Strategic Vision: Working Together For A Stronger Medicare
Since its inception in 1965, Medicare has been leading the way in providing affordable, quality coverage and care, playing a key role in the health and financial security of more than 63 million Americans. As the largest single purchaser of health care—with one in every five health care dollars paid by the program—Medicare serves as a transformative force in the United States. It plays a central role in the Biden Administration’s vision for the Centers for Medicare & Medicaid Services (CMS): to serve the public as a trusted partner and steward, dedicated to advancing health equity, expanding access to affordable coverage and care, and improving health outcomes.
One of the authors, Dr. Meena Seshamani, experienced first-hand the enormous difference that Medicare made for her patients as a practicing physician. And as a former leader of care transformation initiatives for a major health care system, she understands the tremendous opportunities that Medicare’s quality and payment programs have to bring health care sectors together in partnership to truly advance health in our nation. To take just one example, she remembers a successful effort prompted by Medicare’s hospital readmissions reduction program: A community health worker discovered that a woman with chronic obstructive pulmonary disease kept getting readmitted to the hospital with breathing difficulties because her power was shut off in her house, preventing her from using her nebulizer. The community health worker helped resolve the patient’s lack of electricity, and the woman stayed healthy and was not readmitted to the hospital.
In this way, we believe that Medicare can contribute to the meaningful, sustainable changes necessary in our health system to put the person at the center of care. Our goals for Medicare mirror Administrator Chiquita Brooks-LaSure’s vision for CMS writ large: advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and the sustainability of the Medicare trust funds. In this piece, we describe how we are furthering these goals and available opportunities to better align and partner across the health care system.
Advancing Health Equity
Medicare will advance health equity by addressing the health disparities that underlie our health system. As women of color who have dedicated our careers to improving health care in the U.S., we know that these disparities have been especially magnified during the COVID-19 pandemic and have put an enormous strain on families and individuals. We must look at everything we do through the lens of health equity, because when the system doesn’t work, it’s those individuals with complex health and social needs who fall through the cracks.
Building off the Health Equity Plan for Medicare that will soon be refreshed, our approach to advancing health equity is two-fold: improve operations and implement policies that address inequities. For operations, this entails promoting accessibility to health care services (including technology and devices), ensuring that materials developed for people with Medicare are easy to understand, implementing National Standards for Culturally and Linguistically Appropriate Services (e.g., making public-facing materials available in more languages), and expanding data collection, reporting, and analysis to identify disparities and track improvements.
Medicare’s enhanced payment policies will improve access to services for individuals who are at risk of multiple chronic conditions and adverse outcomes and who experience social risk factors that impact their health outside of the four walls of their provider’s office. Overall, we will help those who live in rural areas; cannot afford broadband access; lack access to reliable transportation; have increased risk of COVID-19 infection due to disability, ESRD, or other chronic health conditions; or may experience other barriers to accessing the care they need.
We know we cannot do this work alone. Advancing health equity also requires building the capacity of health care organizations and the workforce to reduce disparities. To start, following Congressional action, we are funding additional medical residency positions in hospitals serving rural and underserved communities—one of the largest increases in partially Medicare-funded residency slots in a decade. We will also work with our provider and payer communities, including Accountable Care Organizations (ACOs) and Medicare Advantage plans, to move care upstream by addressing health-related social needs in the community, which involves expanding ACOs in rural and underserved communities. For example, we aim to provide more transparency to drive improvements in the supplemental health care benefits that Medicare Advantage plans offer, which are medically necessary or furnished to chronically ill individuals in order to improve or maintain an individual’s overall health or function. We want to learn more about how certain Medicare Advantage benefits, such as housing, food, and transportation assistance, meet these requirements and support the health and social needs of people on Medicare.
Expanding Access To Affordable Health Coverage And Care
Since its inception, Medicare has transformed health care for older Americans and people with disabilities. It represents an explicit commitment to health equity regardless of economic, racial or ethnic status. We must never forget these guiding principles and continue to build on this foundation.
We will look to make it easier for people to enroll in Medicare, to eliminate delays in coverage, and to increase enrollment in the Medicare Savings Programs, which provide financial support for those of lower income and resources. We will operationalize learnings from the pandemic to continue to improve access to care. We recently increased payment rates for vaccines and will continue to modernize payment policies to reflect innovations and changes in medical practice.
Driving High Quality, Person-Centered Care
Over the last decade, Medicare accelerated participation in value-based care—those models that reward better care, smarter spending, and improved outcomes. In 2020, the Medicare Shared Savings Program, established by the Affordable Care Act, saved Medicare approximately $1.9 billion, marking the fourth consecutive year of net savings, while the participating ACOs maintained high ratings for quality of care. The promise of these care models has become even more evident during the pandemic. Many ACOs, including ACOs participating in the Medicare Shared Savings Program and the Next Generation ACO model, invested in care managers and community health workers who provided critical support to communities struggling to stay healthy. They were able to work quickly to transition to telehealth and continue to provide needed access to care; they provide the team-based services needed to address the full spectrum of issues arising from the pandemic, ranging from community prevention and health-related social needs to end-of-life support for patients, their families, and caregivers. They’ve shown us that better care coordination, providing care not just within the four walls of a hospital, but across the unique experiences of a person, is key to keeping people healthy.
Building on this foundation, we are working across CMS to enhance the movement towards value-based, high-quality care and to ensure that we are all rowing in the same direction so that 100 percent of people with Original Medicare will be in a care relationship with accountability for quality and total cost of care by 2030. We know that when value-based care programs are not aligned, it can be confusing and counter-productive for providers who see patients across a spectrum of payers, and it can create unnecessary confusion for people with Medicare who stand to benefit from the improvements in quality, support in managing health and social needs, and coordination across health care providers.
Thus, a key part of our strategy will be aligning and coordinating the care models in both Original Medicare and Medicare Advantage. The Center for Medicare is working with the CMS Innovation Center, as part of the Innovation Center’s Strategy Refresh, to align accountable care initiatives and to use the Innovation Center’s authority to test innovative payment and service delivery models that, if successful, could be scaled into the Medicare Shared Savings Program and made available for more people with Medicare.
Additionally, the Center for Medicare, Center for Clinical Standards and Quality, and the Innovation Center are working together to help clinicians who are a part of the Quality Payment Program—both primary care and specialists—continue to drive towards value-based, high-quality care. We must also leverage stakeholder engagement, for example through listening sessions and our communications channels, so that people on Medicare and providers, including specialists, better understand these care models and can provide more input into how they are implemented. We must also continue to build our shared learning collaboratives so we can encourage innovation and transformation in care delivery and evaluate and harness lessons learned.
Promoting Affordability And Sustainability
CMS proudly serves as a responsible steward of public funds. We will work to ensure that Medicare remains affordable for people and sustainable for future generations. The Build Back Better Act, if enacted, will give Medicare stronger tools to address the rising cost of prescription drugs by allowing Medicare to negotiate the prices of high-cost medications, capping Medicare drug spending for individuals in Part D, and preventing unreasonable price increases. We are increasing transparency regarding hospital prices so that people can know what hospitals charge for the items and services they provide. We are also proposing to reinstate more detailed reporting requirements on how Medicare dollars are spent in Medicare Advantage to make sure the health care market is providing value to people. Finally, we will continue to improve payment accuracy and address fraud, waste and abuse.
Engaging Our Partners And The Communities We Serve
All of this work has a common theme: we must work with our partners to put people with Medicare at the center of all that we do. Over the past several months, we have met with numerous stakeholders to listen to their perspectives on where we can work together to drive meaningful change in the health care system. We want to hear ideas on how we can advance health equity, expand access, drive high-quality, person-centered care, and promote affordability and sustainability in the Medicare program. We know that doing so requires deep collaboration across the many sectors that touch peoples’ lives. We are committed to ensuring we integrate the perspectives of the communities that Medicare serves, as well as the providers and health plans that deliver health care, into our policies.
Medicare is the bedrock of our nation’s health system and wields tremendous influence on how our health system operates. Achieving our goals in Medicare will have an outsize influence on the rest of our health system. Let’s look to the work ahead together.