Medicare Officials Call for Consumer-Friendly Reform

Published January 1, 2007

Medicare officials say it’s time to modernize the health plan by providing America’s seniors with more information and choice. But critics say these are just euphemisms for confusion and higher cost.

In many ways, the new Medicare initiatives reflect a shift within the private insurance market to more “consumer-driven” health care. In essence, patients pay part of their health care costs so they have more incentive to stay healthy and choose cost-effective care when they’re sick.

The prescription drug plan launched last year has been the most highly publicized of Medicare’s efforts. But it’s also pressuring hospitals to release more information on cost and quality.

Changing Medicaid

In late 2006, the program started covering more preventive tests, including an introductory physical designed to catch illnesses before they advance.

And this year, Medicare will offer plans similar to health savings accounts, which allow enrollees to pay for some medical costs with tax-free dollars.

“A lot of people think, ‘Consumer-driven health care, here’s a check and here’s a phone book, go figure out what’s best for you,'” said Dr. Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, the federal agency that oversees the programs. “That’s not what this is.”

Still, many of the changes require more money and time from Medicare enrollees. Using quality and cost data requires Internet research. Plans with health savings accounts come with higher deductibles. And patients will have to chip in for the preventive tests, typically paying about 20 percent.

“Beneficiaries have always been responsible for a portion of their cost in Medicare; the problem was the benefits they had available didn’t let them lower those costs,” McClellan said.

Managing Health

Traditional Medicare helped seniors pay for hospital and doctor costs when they got sick, but McClellan said the system’s done little to help people stay well, catch problems early, or manage illnesses with medication.

“In 2006, that’s not the way health care should work,” McClellan said.

Medicare has a big stake in patients managing their health. About 78 percent of Medicare beneficiaries have at least one chronic condition. Nearly two-thirds have two or more. Care for those patients soaks up 95 percent of Medicare’s dollars each year. Medicare officials believe many of those dollars could be saved and patients could stay healthier if their illnesses were better managed.

Part of the challenge is to find doctors and hospitals offering the best care at the lowest cost. Last year, researchers at Dartmouth Medical School found Medicare could have saved about $40 billion–nearly one-third of the total spent–if all hospitals had followed the same highest-quality, lowest-cost practices.

Covering Prescriptions

When Medicare started covering prescription costs last year, McClellan’s theory was to let private firms compete for patients and let patients determine which company offered the best deal for them. At the time, many seniors complained they were overwhelmed by options and unable to wade through so much information.

But a year later, about 90 percent of seniors have drug coverage through Medicare or a former employer. About 80 percent of them told the nonprofit Kaiser Family Foundation they’re happy with their plan. And average costs for the Medicare prescription plans, called Part D, will be lower than expected this year.

“There’s no question that the choice available for Part D was a big change,” McClellan said. “There’s also no doubt that because of competition we are getting the plan we want.”

McClellan said those same concepts of information and choice can help Medicare improve health care quality and patient satisfaction while reducing costs.

“It’s the only way we’re going to keep Medicare sustainable for the future,” McClellan said.

Finding Faults

Not everyone’s convinced.

“In my view, consumer-driven health care is quite poorly designed for this population,” said Jonathan B. Oberlander, a health policy professor at the University of North Carolina-Chapel Hill. “You have to have a reality check about who the Medicare population is.”

Oberlander and other health policy experts say many Medicare patients don’t have access to the Internet or can’t easily navigate it. Others struggle to understand the information.

But Medicare Compare, the Web site with the quality information, has received millions of hits, McClellan notes. He expects more seniors will use the data when there’s more available, such as information on patient outcomes and satisfaction, infection rates, and individual physicians’ success rates. Some of those measures will roll out this year.

Medicare will also launch plans with features similar to health savings accounts. Under the plan, Medicare pays for high-deductible insurance coverage and puts money in an account for the Medicare recipient. The money and its earnings accumulate tax-free as long as they’re used to buy health care. If the money in the account isn’t used, it can roll over to the following year.

Introducing HSAs

Medicare recipients would pay more of their initial costs out-of-pocket, but unlike traditional Medicare there would be a cap on their total spending for the year. McClellan said the program would be good for people who already had an HSA in the private market and are familiar with the concept, and those who want more control over health spending or who need protection from catastrophic health expenses.

But some experts fear Medicare HSAs will attract only healthy recipients without high out-of-pocket costs. Taking them out of the larger Medicare risk pool could make premiums more expensive for everyone else.

“What this is going to do is attract folks who are healthier and wealthier, and that’s going to leave Medicare with the people who are poorer and sicker,” said Stuart Guterman, senior program director for the Commonwealth Fund’s Program on Medicare’s Future. “That’s not good.”

Medicare’s hoping to prevent that by paying insurers more to care for patients who are sicker. And, since these plans will cap patients’ total out-of-pocket costs, they could end up being a better deal for Medicare’s sickest patients, McClellan said.

John Goodman, president of the National Center for Policy Analysis and one of the nation’s most outspoken proponents of health savings accounts, said there’s a chance the introduction of HSAs will skew premiums, but changing Medicare is worth the risk.

“What we have now is a very wasteful system,” Goodman said.

Mary Jo Feldstein ([email protected]) is a staff writer at the St. Louis Post-Dispatch. Reprinted with permission of the St. Louis Post-Dispatch, copyright 2006.