Medicare Remains Viable, Trustees Report Shows, but Challenges Remain

Community Celebrates Survivor’s 100th Birthday

From the American Cancer Society:

There’s no such thing as too many candles. And to prove that point, the small community of Tyler, Texas, celebrated life and victory over cancer by recognizing the 100th birthday of local survivor and American Cancer Society Relay For Life of Smith County Hero Flora Gossett. Diagnosed with colon cancer at age 98, Flora underwent surgery for the first time in her life to remove the cancer. Less than six months later she was back in her own home living life as usual. “She started out having assistance come into the home seven days a week,” says daughter Winifred Johnson. “That really cramped her style as she likes to cook her own food, get herself dressed, and clean her home!”

A member of the St. Louis Baptist church in Tyler for 89 years, Flora was voted unanimously by the church’s Relay For Life team to be their hero for the event. In April, Flora was recognized at the Relay for 99 years of dedication to the community.

“I’m not sure what has contributed to her good health,” says Winifred. “She grew up in a time where everything they ate came from their farm and they walked to get everywhere.”

More than 12 million cancer survivors are celebrating a birthday this year thanks to the progress in the fight against cancer. To join the more birthdays movement with Flora visit morebirthdays.com.

GAO Rejects TRICARE Dental Contract Protest

By ALLISON BELL

Published 5/17/2011 

The U.S. Government Accountability Office (GAO) has let a military dental plan contract award stand.

The GAO has upheld a decision by the TRICARE Management Activity agency at the U.S. Department of Defense to award a $3.1 billion TRICARE dental plan contract to a unit of MetLife Inc., New York (NYSE:MET), rather than to United Concordia Companies Inc., Harrisburg, Pa., a unit of Highmark Inc., Pittsburgh.

TRICARE is a program that provides health coverage for military personnel, military dependents and military retirees who get medical care outside the military and veterans health care systems.

United Concordia has been the TRICARE dental program provider for 15 years.

The new TRICARE dental contract would have provided dental coverage for 2 million TRICARE dental program enrollees for a 12-month base period and 5 1-year option periods.

TRICARE managers reasonably determined that the MetLife provider network was larger and better for meeting TRICARE needs than United Concordia’s network, the GAO says in an explanation of the TRICARE dental contract ruling.

It was also reasonable for the agency to look at the dental carriers’ past contracts, including the magnitude and scope of the services previously performed, officials say.

United Concordia had offered to provide dental coverage for a total of $3.2 billion. It argued that MetLife may have been unrealistic about some of the components used to come up with its price estimate. The GAO found that TRICARE managers had used adequate methods to analyze the price estimate.

United Concordia says in a statement that it is disappointed that the company’s protest was not successful but will do its best to provide high-quality service during the transition period, which will last until mid-2012.

New business outside the TRICARE contract has helped offset the effects of the loss of the TRICARE contract on United Concordia’s overall operations, the company says.

“United Concordia remains one of the largest dental carriers in the world with a very vibrant, growing commercial and government business,” the company says.

Workers: Retirement? What’s That?

Workers: Retirement? What’s That? 

By ALLISON BELL

Published 5/17/2011 

More U.S. workers say they think they will have to postpone retirement.

Researchers at the Transamerica Center for Retirement Studies, Los Angeles, have reported that finding in a summary of results from a recent online survey of 4,080 U.S. workers ages 18 and older working at for-profit employers with 10 or more employees.

Finesse Financial Inc., El Segundo, Calif., reported Monday that the percentage of workers calling its financial helpline who say they feel overwhelmed by their current financial problems is lower than it was in 2009 and in 2010.

The Transamerica Center researchers now say workers' fears about long-term financial well-being continue to grow.

The percentage of workers who said they are "somewhat confident" or "very confident" about being able to live comfortably in retirement has fallen to 51% this year, down from 53% in 2008-2009, and down from 59% in 2007.

The percentage who said they are building a large enough nest egg fell to 38% this year, from 40% in 2008-2009 and 45% in 2007.

When workers were asked about any changes in their expected retirement age in the last 12 months, 40% said they believe they will end up working longer, up from 29% in 2008-2009, and 39% said they expect to work past age 70 or never retire at all.

Only 56% of the workers said they have some kind retirement strategy in mind, and only about 15% to 25% of those workers said they have thought about matters such as long term care insurance, estate planning or dealing with events that force them to retire earlier than they had expected.

Catherine Collinson, president of the Transamerica Center , says in a statement about the survey results that planning to work past age 65 may make sense for some.

"However, it’s important that workers be proactive in setting a retirement savings goal, saving and investing for retirement, and having a backup plan if they are forced to retire sooner than expected," Collinson says.

New Report: Improvements to Medicare are Lowering Costs, Improving Care

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
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New Report: Improvements to Medicare are Lowering Costs, Improving Care

Efforts to improve quality and safety, promote innovation, result in $120 billion in savings for Medicare

 

A new analysis issued today by the Centers for Medicare and Medicaid Services (CMS) outlines savings resulting from improvements to the Medicare program, including implementation of many provisions in the Affordable Care Act, from new tools and resources to help crack down on fraud, waste, and abuse in the Medicare system, to reforming payment systems to reward high quality care.  These efforts are aimed at creating better health, better care, and lower costs for patients, providers, and taxpayers.  The report outlines these provisions, finding that they will save nearly $120 billion for Medicare over the next five years.

Health Care Delivery System Reforms	Savings through 2015
Reforming provider payments -- rewarding quality of care	$55 billion
Improving patient safety -- lowering hospital readmissions and hospital-acquired conditions	$10 billion through 2013*
Cracking down on fraud and abuse in the Medicare system	$1.8 billion**
Getting the best value for Medicare beneficiaries and taxpayers for durable medical equipment	$2.9 billion ($17 billion over ten years)
Reducing excessive Medicare payments to insurance companies	$50 billion

“Just a year after passage, we are seeing savings in Medicare begin to materialize from provisions in the Affordable Care Act,” said Donald Berwick, MD, CMS Administrator.  “This work is laying the groundwork for a larger transformation of Medicare and our health care delivery system, from simply paying for the volume of services provided to rewarding the quality of care delivered.  We remain committed to achieving a health care system that pursues better care, better health, and lower cost through improvement.”

In addition to the provisions generating savings to date, the report highlights several steps CMS is taking to achieve long-term savings and reform the health care delivery system:

·       Better coordinated care for individuals enrolled in Medicare and Medicaid;

·       Creation of the Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models;

·       Promotion of Accountable Care Organizations;

·       Broader value-based purchasing programs;

·       Creation of the Independent Payment Advisory Board to recommend ways to best improve quality of care for Medicare beneficiaries while lowering costs;

·       Expanding use of Electronic Health Records;

·       Administrative Simplification;

·       Medicare Advantage payment reform;

·       Enhanced program integrity, fraud, waste, and abuse prevention work;

·       Promoting prevention and wellness.

For the full report, please visit: http://www.cms.gov/apps/files/medicare-savings-report.pdf

CMS Dual Beneficiary Numbers

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Room 352-G
200 Independence Avenue, SW
Washington, DC 20201
Office of Media Affairs

In 2008, there were 9.2 million individuals eligible for both the Medicare and Medicaid programs.[i]  Medicare-Medicaid enrollees, “dual eligibles,” are among the most chronically ill and costly individuals enrolled in both the Medicare and Medicaid programs, with many having multiple chronic conditions and/or long-term care needs.  More than half of Medicare-Medicaid enrollees have incomes below the poverty line[ii] compared with 8 percent of other Medicare beneficiaries.[iii]  Forty-three percent of Medicare-Medicaid enrollees have at least one mental or cognitive impairment,[iv] while 60 percent have multiple chronic conditions.[v]  Nineteen percent live in institutional settings compared to only 3 percent of Medicare beneficiaries who are not also eligible for Medicaid.⁵  This group must navigate two separate programs: Medicare for coverage of basic acute health care services and drugs, and Medicaid for coverage of long-term care supports and services, and help with Medicare premiums and cost-sharing. 

Medicare-Medicaid enrollees account for a disproportionately large share of expenditures in both the Medicare and Medicaid programs: accounting for 16 percent of Medicare enrollees, yet 27 percent of Medicare spending in 2006.[vi]  In Medicaid, they comprised only 15 percent of enrollees but represented 39 percent of Medicaid spending in 2007.[vii]  

-more-

To see the rest of the CMS Fact Sheet please visit: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=3954  

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Room 352-G
200 Independence Avenue, SW
Washington, DC 20201
Office of Media Affairs

National Women's Checkup Day

National Women’s Checkup Day is dedicated to encouraging women to visit health care professionals to get or schedule a checkup and to promote regular checkups as vital to the early detection of heart disease, diabetes, cancer, mental health illnesses, sexually transmitted infections (STIs), and other conditions.

Women’s Checkup Day is part of National Women’s Health Week. The theme for 2011 is "It's Your Time." National Women's Health Week empowers women to make their health a top priority. It also encourages them to take steps to improve their physical and mental health and lower their risks of certain diseases. Those steps include:

• Getting at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of both, each week
• Eating a nutritious diet
• Visiting a health care professional to get regular checkups and preventive screenings
• Avoiding risky behaviors, such as smoking and not wearing a seatbelt
• Paying attention to mental health, including getting enough sleep and managing stress

Learn more about National Women's Health Week.