4: Consumers
Confident, Informed Consumers Other Information:
CMS will develop personal relationships with beneficiaries through the use of increasingly personalized tools and with the
cooperation of a well-developed grassroots network of partners. The goal is to ensure that our beneficiaries become confident,
well-informed consumers that make maximum use of the program. Doing this will result in a successful system of personalized
health care – the right care at the right time. Consumers will participate in SMART health care and have immediate access
to affordable Medicare prescription drugs, comparative information on quality and cost, flexible Medicaid benefits and incentives,
and access to care in homes and communities for the disabled population. The New Orleans Health System will become prevention-centered,
neighborhood-located and electronically-connected. CMS’ ongoing projects include efforts to maintain and expand our use of
technology, including beneficiary e-Services via medicare.gov and upgraded call centers. Our efforts also include maintaining
a multi-pronged approach for various outreach and awareness campaigns at the national, regional, and local levels regarding
beneficiary rights, benefits, and health care options. We support the activities of the Ombudsman in helping beneficiaries
make better health care choices in addition to providing technical assistance and training to stakeholders involved in educating
beneficiaries about Medicare. Through expanded use of the self-directed personal care state plan option, the new Home and
Community Based Services (HCBS) State plan option, and HCBS waivers, we are increasing the number of people who have the option
to self-directed Medicaid services. We are also developing and disseminating patient-focused promotional materials designed
to communicate the Agency’s various health care initiatives to promote good health and disease prevention. CMS’ initiatives
through 2009 include: Personal Health Records (PHR) CMS continues to work to give our beneficiaries more control and use of
their own electronic health information, with their permission and control and with full security protections. We have launched
the Medicare Beneficiary Portal at my.medicare.gov, an online tool that will enable beneficiaries to get access to all their
Medicare information, such as Fee-for-Service (FFS) claims, deductibles, eligibility, enrollment and other personal data.
Implementing PHRs also means enhancing our security systems. We are the largest maintainer of health-related information in
the world. CMS is committed to protecting the security and privacy of our sensitive beneficiary health care data. How we protect
and manage that information is not only a critical service for our customers, but it sets a standard for the larger health
care system. CMS will continue promoting the use of personal health records by: • Conducting a PHR feasibility study; • Actively
supporting the PHR activities of the Office of the National Coordinator (ONC) and the American Health Information Community
(AHIC); • Developing a process for the secure transmission of Medicare information to populate the PHRs for beneficiaries
who have chosen to use them; • Participating in Secretary’s Advisory committee for EHR, AHIC; and • Working with industry
groups on developing standards for PHRs that will support the Medicare and Medicaid populations. Electronic Prescribing The
ability to create electronic prescriptions (e-Rx) has obvious implications for quality improvement and cost savings. Medication
errors due to handwriting or similar errors caused by a paper-based process can be significantly reduced by prescribing through
a computer or hand-held device and electronically transmitting that prescription to a pharmacy. The Medicare Modernization
Act requires us to implement e-prescribing no later than 2009. This e-prescribing requirement is also a stepping stone in
moving the Secretary’s Health Information Technology initiative forward. We have already significantly accelerated the e-prescribing
schedule by publishing a set of standards for communicating basic e-prescribing transactions and awarded contracts to conduct
five pilot programs that will test additional standards, interoperability and workflow. We will continue in this direction
by: • Developing plans to inform and educate health professionals, and to partner with key players in the health care industry
to encourage adoption of e-prescribing; • Evaluating the pilots and report to Congress the results in 2007; and • Promulgating
final uniform standards in 2008 Beneficiary Contact Centers A key outcome of reforming the fee-for-service environment, responding
to a projected 40 million calls a year, and improving customer service in Medicare is the implementation of the Beneficiary
Contact Center. By focusing our operations on larger call center contractors we are able to improve operational efficiency,
reduce operating costs and improve service to callers (more consistent and accurate). This strategy allows us to respond quickly
and efficiently to general inquiries that will be handled by the Internet, national IVR and 1-800-MEDICARE customer service
representatives while routing more complex telephone inquiries to contractors providing the best value and the most qualified
agents. Additionally, we are able to develop and implement centralized standards and approaches to core call center functions,
i.e., quality assurance, training development, and content development, so that beneficiaries get understandable, usable,
and accurate information every time. Specifically, the CMS strategy includes: • Maintaining the network Interactive Voice
Response (IVR) system that will provide beneficiaries 24X7 access to information; • Making 1-800 MEDICARE’s standard desktop,
the Next Generation Desktop (NGD), the standard desktop for all call centers so that all the virtual call centers have access
to all data systems necessary to answer Medicare inquiries; and • Establishing one national information warehouse. Money to
follow the person (MFP) in State Medicaid program The 2005 Deficit Reduction Act authorizes the Secretary to award grants
to States to eliminate barriers or mechanisms that prevent or restrict the flexible use of Medicaid funds. The grants were
created to enable Medicaid-eligible individuals to receive support for appropriate and necessary long-term care services in
the setting of their choice. Specifically, CMS will be: • Offering $1.75 billion in competitive grants to the states for a
period of 5 years, starting in January 2007; • Giving an MFP-enhanced Federal Medical Assistance Percentage rate for a period
of one year for each person that the State transitions from an institution to the community; and • Educating states about
the benefits and availability of the MFP program. Up-to-date Medicaid benefit choices and personal consumer responsibility
about health care choices Medicaid has tremendous potential to give beneficiaries more choice, especially with the implementation
of the DRA. DRA gives states many more options of delivering benefits. CMS will encourage all states to use these new benefit
flexibility options to realize Medicaid innovation and efficiencies. To this end, we will be: • Providing clear policy direction
to help all states to use new benefit flexibility options; • Reviewing and approving benefit flexibility State Plan Amendments
expeditiously; and • Increasing flexibility options to States by identifying ways states may begin the process of incorporating
Health Opportunity Accounts into the Medicaid programs. Medicare Health Support Pilot Program Section 721 of the Medicare
Prescription Drug, Improvement and Modernization Act of 2003 authorized the development and testing of voluntary chronic care
improvement programs, called Medicare Health Support programs, to improve the quality of care and life for people living with
multiple chronic illnesses. Implementation of the Medicare Health Support program is the first large-scale initiative of this
type for selected chronically ill populations in traditional fee-for-service Medicare. This new Medicare initiative is designed
to help reduce health risks, improve quality of life, and provide savings to the beneficiaries and to Medicare. As of Spring
2006, more than 120,000 Medicare beneficiaries had agreed to participate in these programs. Now that these pilots are underway,
we will continue to evaluate the progress of these pilots, and will be • Submitting an interim report to Congress on progress
to date in 2007; and • Submitting a second report to Congress on pilot findings in 2009. Pandemic Flu HHS is engaged in a
broad array of activities to prepare for an influenza pandemic, and CMS plays a supportive role in this effort. Building off
of the successful development and implementation of our Continuity of Operations Plan, we have developed a plan in the event
of an influenza pandemic that supports the HHS plan. We have established relationships with Federal, State, and local officials,
and tribal partners and are able to work with them to develop surge capacity for deploying of medical resources during an
outbreak. To further our preparedness, CMS efforts include: • Developing policy-specific: (a) standards for emergency preparedness
for providers and agents, (b) standards for quality and service delivery performance, and (c) policies and procedures for
adjusting standards to match emergency situations (e.g., waivers or deferrals under section 1135 authority); • Enhancing Business
Continuity Plan (BCP) policies that address critical employees, time and compensation issues, continuity of business functions,
work at home; • Continue building and maintaining employee call rosters and critical employees; • Continuing to train critical
employees on duties and responsibilities and cross-train staff on essential functions; • Strengthening shelter-in-place (SIP)
plans and train critical employees on shelter-in-place/quarantine possibilities; and, • Conducting tests and exercises to
assess, validate, or identify a subsequent corrective action for specific aspects of plans, policies, procedures, systems
and facilities used in response to an emergency situation. Transparency: Availability of accurate and comparative information
for beneficiaries During the drug benefit implementation, we saw beneficiaries input their specific drug information to get
detailed reports on which drug plan would provide the greatest value. We are well-positioned to update our award-winning comparative
tools. During the next few years, we will be: • Working to use up-to-date IT systems to help beneficiaries and the organizations
that support them to get the personalized assistance they need to take advantage of Medicare’s new coverage and new information
on quality and costs; • Continuing to improve and expand the content of Hospital Compare, Home Health Compare, Nursing Home
Compare, and Dialysis Facility Compare; • Developing transparency collaborations to ensure beneficiaries get the best quality
care for the best price by developing ways to let a beneficiary know their medical options, the quality and expertise of doctors
and hospitals in their area, and what their medical care will cost them before they need a specific type of care. • Encouraging
our beneficiaries to become more confident and informed participants in choosing their health care; and, • Publishing reimbursements
rates for common procedures and treatments. Transparency: Quality information on disease prevention and management CMS is
working to support and collaborate on the development of useful quality measures in virtually all areas of care. Much of this
activity is taking place through broad partnerships focused on measuring quality and then achieving measurable improvements
in quality. CMS is one of many stakeholder participants in these collaborations. The measures being developed, applied, and
improved through these collaborations include: • Expanding the hospital quality measures to include outcomes such as patient
satisfaction and surgical complications. These measures are developed through the joint efforts of CMS, the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO), the Agency for Healthcare Research & Quality (AHRQ), and members of
the Hospital Quality Alliance (HQA), and endorsed by the National Quality Forum. • Developing measures of ambulatory care
quality and efficiency; • Continue enhancing nursing home quality with the Nursing Home Quality Initiative, taking further
steps to improve additional important outcomes and efficiency, such as to reduce pressure ulcers and avoid hospital admissions
with preventable complications; • Providing information on health plan performance (including prescription drug plans); •
Collaborating in other areas of quality measurement, including home health care, dialysis care, and performance measures specifically
related to Medicaid and SCHIP populations; • Improving cancer care, which involves measurement in an effort to understand
what care is actually being provided and whether it is meeting our beneficiaries’ needs for comfort and support; and • Continuing
to support and rely on the National Quality Forum (NQF). Medicare Advantage In 2006, all Medicare beneficiaries have access
to at least one type of private Medicare Advantage plan. The increase in access (up from 77 percent in 2004) stems largely
from the creation of new Medicare regional PPOs and the expansion of private Medicare fee-for-service plans. With Medicare
Advantage, beneficiaries can save about $80 a month compared to the traditional plan with or without a Medigap plan they purchase
on their own. To continue to ensure Medicare Advantage is universally available, and ensuring beneficiary choices, CMS will:
• Continue to encourage new regional PPOs so that the availability of regional PPOs extends beyond the 2006 level of 70 percent;
• Continue to educate health plan organizations and encourage plans to participate; • Continue to streamline and automate
the application and bidding process to reduce the burden for plan participation; and • Use the stabilization fund (under the
authority of the Secretary), to provide incentives to Regional PPOs to remain in areas with below-national-average MA market
penetration or enter MA regions with low or no participation by reducing administrative obstacles to using the fund data systems
capacity for Baby Boomers. Data systems capacity for Baby Boomers The baby boomers are a different population than our current
beneficiaries. They are more willing to put their health data in an electronic format; they are more Internet savvy. Baby
Boomers will use our tools to assist their parents (current beneficiaries), and ultimately to address their own needs. Unless
we are modernizing our systems, we won’t be able to sustain our programs. Accordingly, over the next few years, we will: •
Maintain a robust, stable, and modernized enterprise-wide IT environment; • Implement the Medicare and Medicaid IT Architecture;
• Strengthen the data infrastructure; • Implement an Integrated Data Repository • Continue maturation of the CMS Enterprise
Architecture; and • Continue to implement the enterprise data centers. Beneficiary outreach and education on coverage, services,
and privacy CMS is committed to protecting the security and privacy of our sensitive beneficiary health care data. As we continue
to implement the Health Information Technology strategy, CMS must continue to ensure the public that we are safeguarding individual
privacy and ensure they understand not only the program coverage and services, but also their privacy rights and protections.
To that end, we will: • Continue to use the media to alert beneficiaries of activities that may infringe these rights; • Continue
to use and expand our many information vehicles (medicare.gov, 1-800-MEDICARE, publications/fact sheets) and partners to educate
beneficiaries on coverage, services, and the privacy and security of their personal information; and • Integrate the CMS Office
of External Affairs with supporting program goals by 2009.
Objective(s):
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