Affordable Care Act Saves $260 Million This Year

Tue, 28 Jun 2011 17:51:00 GMT

http://support.medicarecrm.com/News/13/affordable-care-act-saves-260-million-this-year.aspx Tue, 28 Jun 2011 17:51:00 GMT newsitem13

By Donald M. Berwick, M.D., Administrator, Centers for Medicare & Medicaid Services

Thanks to the Affordable Care Act, almost half a million individuals enrolled in Medicare’s prescription drug benefit have received a 50 percent discount on their out-of-pocket costs in the first five months of 2011.

Because of Medicare improvements in the Affordable Care Act, beneficiaries now automatically receive a 50 percent discount on covered brand-name drugs in the Part D coverage gap, or “donut hole,” and have saved more than $260 million so far this year.

In May alone, we have seen a 76 percent increase in the number of beneficiaries receiving this discount (478,272 individuals through the end of May compared to 270,900 through the end of April). In addition, the total savings these beneficiaries received grew over 56 percent in one month, for a total average savings of $545 per beneficiary (for state-by-state figures, please click here).

Most of these discounts are helping Americans with serious medical conditions – nearly 14 percent of the benefits provided to date – more than $36 million – are for cancer drugs, more than 8 percent or $21 million for drugs to help control high blood pressure and cholesterol, and another more than 7 percent – about $20 million – are for drugs provides to diabetic patients.

As more and more beneficiaries hit the donut hole through the rest of this year, the numbers will continue to climb. All of these beneficiaries will see savings on their drug costs that were not available in previous years.

And cheaper prescriptions are just one of the many ways the Affordable Care Act is improving Medicare for seniors. Thanks to the new law, many preventive care screenings are available free of charge. As of June 10, we found that about 5.5 million people with Medicare have accessed one or more preventive measures and last week, we launched a new awareness effort– Share the News, Share the Health – to highlight Medicare’s preventive benefits and encourage Medicare beneficiaries taking advantage of these potentially lifesaving services.

More information on the free preventive services that are available to people on Medicare can be found on the “Manage Your Health” tab at www.Medicare.gov.

View Dr. Donald Berwick's Recorded Remarks from the ACO Accelerated Development Learning Session

Tue, 21 Jun 2011 17:50:00 GMT

http://support.medicarecrm.com/News/14/view-dr-donald-berwicks-recorded-remarks-from-aco.aspx Tue, 21 Jun 2011 17:50:00 GMT newsitem14 View Remarks

New CMS campaign to educate seniors about new free preventive care provided by Affordable Care Act

Mon, 20 Jun 2011 17:55:00 GMT

http://support.medicarecrm.com/News/15/new-cms-campaign-to-educate-seniors-about-new-free.aspx Mon, 20 Jun 2011 17:55:00 GMT newsitem15

For Immediate Release:	Monday, June 20, 2011
Contact:	CMS Office of Public Affairs 202-690-6145

MORE PEOPLE WITH MEDICARE RECEIVING FREE PREVENTIVE CARE

New CMS campaign to educate seniors about new free preventive care provided by Affordable Care Act

The Centers for Medicare and Medicaid Services (CMS) today released a new report http://downloads.cms.gov/files/preventionreport.pdf showing that more than 5 million Americans with traditional Medicare – or nearly one in six people with Medicare – took advantage of one or more of the recommended preventive benefits now available for free thanks to the Affordable Care Act. Also today, Medicare launched a nationwide public outreach campaign, including a letter to doctors and a new Public Service Announcement that will raise awareness about all of the important preventive benefits now covered at no charge to patients, including the new Annual Wellness Visit benefit created by the Affordable Care Act.

“The Obama Administration is committed to helping increase the number of Americans who are healthy at every stage of life, said CMS Administrator Donald Berwick, M.D. “Even in your 70s, 80s, or beyond you can reduce your risk of disability and chronic illness if you take care of yourself. With the new free Annual Wellness Visits and free preventive care, people with Medicare have the tools to take common-sense steps to take control of their health.”

“Further, it’s important to get the tests which can spot a serious illness early when it can be best treated,” said Dr. Berwick. “These preventive screenings are critical, and we want physicians to take this opportunity to help their older patients understand how necessary they are.”

“The Administration on Aging network of service providers are the ‘boots on the ground’ in reaching people on Medicare," said Assistant Secretary for Aging Kathy Greenlee. "These providers see Medicare beneficiaries every single day at a variety of settings across the country, and serve a diverse group population. I am committed to ensuring that the Medicare beneficiaries we serve are aware of and take advantage of their Medicare preventive benefits.”

According to the report, over 5.5 million beneficiaries in traditional Medicare used one or more of the preventive benefits now covered without cost-sharing including, most prominently, mammograms, bone density screenings, and screenings for prostate cancer. In 2011, Medicare began covering an Annual Wellness Visit at no cost to Medicare beneficiaries. As part of that visit, beneficiaries and their physicians can review the patient’s health and develop a personalized wellness plan. Over 780,000 beneficiaries received an Annual Wellness Visit between January 1 and June 10. Additionally, more seniors have used the Welcome to Medicare Exam this year. 66,302 beneficiaries had taken advantage of the benefit by the end of May 2011, compared to 52,654 beneficiaries at the same point in 2010 – a 26 percent increase.

A renewed push toward prevention is the latest step toward CMS’s fulfillment of its “Three-Part Aim”: Better care and better health at lower cost through improvement in health care. Roughly 70 percent of Medicare beneficiaries had at least one chronic condition in 2008, while as many as 38 percent had between two and four chronic conditions, and 7 percent had five or more. They see an average of 14 different doctors and fill an average of 50 prescriptions or prescription refills a year. Preventing chronic disease among the Medicare population would not only improve their health and quality of life, it could help save an estimated two-thirds of the $2 trillion the U.S. spends treating preventable long-term illness today.

The new annual wellness visit can help spark the beginning of an ongoing conversation between patients and their doctors on how to prevent disease and disability. At this visit, beneficiaries can review their histories and make sure their primary care doctor knows about their other providers and prescriptions. They can also talk about the pros and cons of getting an influenza, pneumococcal or hepatitis B vaccination, or find out whether a diabetes test, a bone mass measurement, or any of several cancer screenings would be right for them. Thanks to the Affordable Care Act, Medicare now covers many of these services without cost to patients.

Medicare’s Share the News, Share the Health campaign will run throughout the summer, with online ads and community events all over the country starting in July. HHS is releasing a nationwide public service announcement that is available on http://www.youtube.com/user/CMSHHSgov#p/u/4/ALyKuNUTMwM As part of these outreach efforts, CMS has issued a “Dear Doctor” letter to providers today, calling on them to discuss preventive care with their patients.

The agency also launched the full Spanish version of the www.Medicare.gov website, http://es.Medicare.gov. In addition, Medicare’s dedicated caregivers’ website “Ask Medicare” (www.Medicare.gov/caregivers) now has a prevention section especially for caregivers. You can find additional information on prevention benefits on line at www.Medicare.gov, and at www.healthcare.gov (click on "Learn about Prevention" at the top).

This announcement comes during Prevention & Wellness Month, as the Obama Administration is highlighting announcements, activities, and tips that will help Americans get healthy and stay healthy. Last week, the National Prevention Council released the National Prevention Strategy, America’s plan to help increase the number of Americans who are healthy at every stage of life. The Community Transformation Grants are one piece of a broader effort to address the health and well-being of our communities through initiatives such as the President’s Childhood Obesity Task Force, the First Lady’s Let’s Move! campaign, the National Quality Strategy, and HHS’ Communities Putting Prevention to Work program. The Prevention and Public Health Fund, as part of the Affordable Care Act, is supporting this and other initiatives designed to expand and sustain the necessary capacity to prevent disease, detect it early, manage conditions before they become severe, and provide States and communities the resources they need to promote healthy living.

NEW TECHNOLOGY TO HELP FIGHT MEDICARE FRAUD

Fri, 17 Jun 2011 17:56:00 GMT

http://support.medicarecrm.com/News/16/new-technology-to-help-fight-medicare-fraud.aspx Fri, 17 Jun 2011 17:56:00 GMT newsitem16

For Immediate Release:	Friday, June 17, 2011
Contact:	CMS Office of Public Affairs 202-690-6145

NEW TECHNOLOGY TO HELP FIGHT MEDICARE FRAUD

Technology is Similar to Tools Used by Credit Card Companies, Builds on White House Campaign to Cut Waste

On the heels of the White House launch of the Campaign to Cut Waste - an administration wide initiative to crack down on waste, fraud and abuse, the Centers for Medicare & Medicaid Services (CMS) announced today that starting July 1, it will begin using innovative predictive modeling technology to fight Medicare fraud. Similar to technology used by credit card companies, predictive modeling helps identify potentially fraudulent Medicare claims on a nationwide basis, and help stop fraudulent claims before they are paid. This initiative builds on the new anti-fraud tools and resources provided by the Affordable Care Act that are helping move CMS beyond its former “pay & chase” recovery operations to an approach that focuses on preventing fraud and abuse before payment is made.

“President Obama is committed to hunting down and eliminating waste, fraud and abuse throughout the federal government,” said HHS Secretary Kathleen Sebelius. “Our work to fight Medicare fraud is an important part of the Obama Administration’s effort to root out wasteful spending and change the way government does business.”

“Today’s announcement is bad news for criminals looking to take advantage of our seniors and defraud Medicare,” said CMS Administrator Donald Berwick, M.D. “This new technology will help us better identify and prevent fraud and abuse before it happens and helps to ensure the solvency of the Medicare Trust Fund.”

Original Medicare claims will be analyzed using innovative risk scoring technology that applies effective predictive models, an approach similar to that used by the private sector to successfully identify fraud. For the first time, CMS will have the ability to use real-time data to spot suspect claims and providers and take action to stop fraudulent payments before they are paid.

Northrop Grumman, a global provider of advanced information solutions, has been selected through a competitive procurement to develop CMS’ national predictive model technology format using best practices of both public and private stakeholders. Northrop Grumman has partnered with National Government Services (NGS) and Federal Network Systems, LLC, a Verizon company (FNS), to leverage the wealth of claims data and its information to fight health care fraud. CMS used industry guidance, innovative ideas from private and provider entities and related data in developing the scope of work for this national fraud prevention program. Given the importance of this contract to CMS’ overall anti-fraud efforts, this contract is being implemented nationally and ahead of schedule.

“CMS has worked with public and private stakeholders throughout the process of developing this program, and the key insight they shared on their successes and innovations have helped ensure it will significantly help us address fraud in the Medicare program,” said Peter Budetti, M.D, J.D., director of CMS’ Center for Program Integrity (CPI).

Northrop Grumman, through the use of proven predictive models and other advanced analytics, will move rapidly to implement the new technology. Northrop Grumman will deploy algorithms and an analytical process that looks at CMS claims – by beneficiary, provider, service origin or other patterns — to identify potential problems and assign an “alert” and assign “risk scores” for those claims. These problem alerts will be further reviewed to allow CMS to both prioritize claims for additional review and assess the need for investigative or other enforcement actions.

“Predictive modeling is a revolutionary new way to detect fraud and abuse, integrating effective and timely actions with protections and savings for Medicare and taxpayers,” Dr. Budetti said.

More information on the predictive modeling and HHS’ effort to detect fraud and abuse are availablewww.HealthCare.gov/news/factsheets/fraud03152011a.html and through its news portal at www.HealthCare.gov, made available by the US Department of Health and Human Services.

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Affordable Care Act Saves $260 Million This Year

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NEW TECHNOLOGY TO HELP FIGHT MEDICARE FRAUD