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McClellan Says Preventive Care Next Focus for CMS

MAY 19, 2006 -- With the May 15 Medicare prescription drug plan enrollment deadline over, program officials are gearing up for another major campaign — increasing beneficiaries' use of preventive services, Centers for Medicare and Medicaid Services Administrator Mark B. McClellan said Friday.

At a luncheon briefing co-sponsored by the Galen Institute and the Council for Affordable Health Insurance, McClellan said CMS officials are now tracking how beneficiaries use the program's preventive services to make sure that beneficiaries who need those services are receiving them. One possible improvement would be to increase screenings for diabetes and heart disease among beneficiaries in minority groups, McClellan said.

With Medicare now covering prescription drugs, "we've closed the benefit gap. The next step is to close the prevention gap," McClellan said.

Preventive services within Medicare include a one-time physical for new enrollees, cardiovascular screening, cancer screenings and flu shots. To increase the awareness and use of these benefits, McClellan said he envisions CMS officials working with community organizations throughout the country, just as they did to promote enrollment in the drug benefit.

"The grassroots approach in Medicare is here to stay," he said.

Improving beneficiaries' use of preventive services is part of McClellan's larger vision of personalizing Medicare benefits for enrollees. The program must do more to help beneficiaries manage their medical care rather than just paying the bills for it, he said.

McClellan also told the health policy analysts and journalists in attendance that health savings accounts, or HSAs, including both drug coverage and health benefits, are likely to be part of the coverage choices offered to Medicare beneficiaries next year.

The accounts, which were created in the 2003 Medicare drug law (PL 108-173), allow individuals who sign up for high-deductible health plans to contribute and withdraw funds to cover health care costs tax-free. Proponents of HSAs say that when patients are forced to pay more costs out of pocket, they will begin to comparison shop and request quality data, eventually driving down health care costs.

McClellan said 90 percent of Medicare beneficiaries enrolled in the drug benefit selected a plan that was different than the standard benefits package designed in the Medicare drug law. According to McClellan, beneficiaries are selecting plans with lower or no deductibles or plans that fill in the gap in coverage known as the "doughnut hole"—the part of the benefit in which Medicare picks up none of the costs of a prescription until yearly out-of-pocket prescription drug outlays grow large enough to trigger "catastrophic" protection, in which Medicare pays 95 percent of prescription costs.

McClellan predicted that a strong market would remain for Medicare prescription drug plans offered to beneficiaries in Medicare's traditional fee-for-service programs, but he said he also is seeing "a lot of growth" in Medicare Advantage plans that offer drug coverage and other health care benefits.

"You're going to see plans making their reputation over the next year," McClellan said.

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