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  • Efforts to Reduce Disparities in Care for Medicare BeneficiariesPeter B. Bach, MD, MAPPSenior Adviser, Office of the AdministratorCenters for Medicare & Medicaid Services

  • TodayThe Agency philosophy regarding health disparitiesProgrammatic initiatives in health disparitiesSpecific health disparities initiativesTrying to move forwardWhat should we do?What can we do?

  • Agency PhilosophyAll quality initiatives should be evaluated in light of their potential impact on the health of minority populationsWill adequate groups be included in demonstrations?Will methodology or risk selection adversely affect minorities?Are appropriate suites of measures being chosen to drive improvements in minority health?

  • Agency Philosophy contd Specific quality initiatives should focus on directly addressing identified mechanismsShould be assessed based on impact on patients, including satisfaction with care and outcomes

  • Mechanisms underlying disparitiesCommunication and comprehension barriersDifferences in accessDifferences in coverage

    To better define mechanisms:Projects, interventions, demonstrations and research

  • CommunicationNational Medicare Education Program (NMEP) 1997 BBA

    Includes:1-800-Medicarewww.medicare.govMedicare & You HandbookHORIZONSOther

  • HORIZONS (Health Outreach Initiative Zeroing in On Needs)Formed to identify strategies to reach hard to reach populationsToolkits created for outreach to: African Americans; Asian American/Pacific Islander; Hispanic American Include: Handbooks, print brochures, media scripts

  • REACH Regional Education About Choices in Health CareImplemented by CMS Regional Offices to increase access to Medicare informationTargets: -Low Income -Location -Language-Literacy-Culture

  • State Health Insurance Assistance Programs (SHIPs)Funded by CMS to provide counseling to Medicare beneficiariesSpecifically about issues related to Medigap and drug coverageCounselors community based, often volunteersPresent in all 50 states + D.C.Mandated to target underserved populations (usually defined by income)CMS has developed training materials (English and Spanish) in counseling and cultural competency

  • AccessSpecific concerns about lack of proper healthcare facilities locally available to minority populationsHealth Care Infrastructure Improvement Program Sec 1016 of MMALarge loans to facilities to build-out cancer care infrastructureSpecifically targeted at geographic regions where there are large populations of Native AmericansTremendous amount of infrastructure work focused on geographic availability of drug benefit and DME

  • Coverage differencesNot all beneficiaries have the same coveragePart B coverage requires co-pays and has a deductibleMinorities more likely to have Medicaid 32% of blacks; 9% of whitesMinorities more likely to have no coverage20% of blacks, 14% of whites

  • Coverage differencesImportant preventive services no longer need co-pay and do not affect deductibleVaccines influenza, pneumococcal, Hep BCancer screening mammograms, PSA test, FOBTChange in Part B drug reimbursement to ASPEffect should be that physicians payments more similar when treating patients with Medicare and Medicaid than previously

  • Specific programs and interventions

  • Utilization and Access to CareHealth Disparities: Measuring Health Care Use and Access for Racial/Ethnic PopulationsAnalyzes health care access trendsAssesses validity of race/ethnicity data in the Medicare enrollment database

  • READIIRacial and Ethnic Adult Disparities in Immunization InitiativeCMS collaborates with CDC to improve flu and pneumococcal immunization rates Focuses on African Americans and HispanicsFive locations:Chicago, ILBexar County (San Antonio vicinity), TexasMilwaukee, WIMonroe County (Rochester vicinity), NYSelected Counties, rural MS

  • QIOs

    Quality Improvement OrganizationsEstablished by legislation in 1982 to improve quality of carePresent in all 50 states and U.S. territoriesUndertake special efforts in health care, including specific diseases and disparities in minority populationsQIOs are on the ground, working with providers, beneficiaries, and networks

  • QIO Disparity Projects

    1999-200251 projects2002-2005 52 projectsInclude global measures on diabetes, mammography screening, immunization, and heart failure

    Two tasks in next scopeWork with providers who treat underserved to use IT more effectively (DOQ-IT)Promote provider and practice system changes to achieve CLAS (culture and language) standards and cultural competency

  • Medicare Advantage Plans Ensure that all services are accessible to allQIOs charged with improving care in these plansThe QAPI project requires plans also to improve cultural competence, either as manifest by reducing a clinical health disparity or by developing cultural initiatives

  • HBCU Grant Program

    Historically Black Colleges and Universities Health Services Research Grant ProgramSmall applied projects awarded to:Remove barriers and improve healthIncrease efficient utilizationImprove qualityReduce health care costsImprove HIV and AIDS outcomes

  • CMS Demonstrations Physician Group Practice DemonstrationMedicare Health Support (CCIP)Cancer prevention and treatment

  • Physician Group Practice DemonstrationAwardees are 10 large physician group practicesFocuses on the quality of preventive care and ultimately on the outcomes of beneficiaries treated by the groups Incentives for practices better efficiency and outcomes will result in bonus payments

  • Medicare Health SupportFormerly the Chronic Care Improvement Program (CCIP)Beneficiaries with specific conditions congestive heart failure and diabetes who reside in target regionsRegions (10) chosen for high prevalence Chicago, DC, Georgia, Mississippi, Brooklyn/QueensRandomized study where enrollees can receive additional care managementObjective is to enhance existing physician-patient relationships

  • Cancer Screening & TreatmentCancer Prevention and Treatment Demonstration for Ethnic and Racial MinoritiesDefined racial and ethnic minority groupsSites (rural and inner city) will facilitate cancer screening, diagnosis and treatmentCharged with funding 9 sites

  • Screening and TreatmentRandomized designsInvited participants: Care management organizations, health insurers, group practices, academic health centers, minority serving institutionsTwo promising strategies addressedRisk assessment assistancePatient navigation/community health workers

  • Cancer Screening Demo StatusSolicitation was published in the Federal Register on 12/23/04Proposals were due 3/23/05Award is expected mid-2005Full-scale implementation in Fall 2005

  • Other Initiatives HHS Closing the Health Gap campaignTake a Loved One to the Doctor Day initiativeBroadcasts on ABC Radio NetworksCelebra La Vida Con Salud initiativeCelebrate a Healthy Life

  • Summary In addressing this problem, CMS: Recognizes the magnitude of the problemRecognizes it has a special responsibility to address the problemLeverages all Agency resourcesSeeks ideas, suggestions, and support from ALL!

  • FOR MORE INFORMATION1-800-MEDICAREwww.medicare.govwww.cms.hhs.gov

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