Meena Seshamani, MD, PhD�Director, Center for Medicare

Advancing Equity through the

CMS Innovation Center

The CMS Innovation Center Statute

“The purpose of the [Center] is to test innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care furnished to individuals under such titles.”

Alternative Payment Models can apply to a specific:

• Health condition, like end-stage renal disease
• Care episode, like joint replacement
• Provider type, like primary care providers
• Community, like rural areas
• Innovation within Medicare Advantage or Medicare Part D

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CMS has engaged the health care delivery system and invested in innovation across the country

Source: CMS Innovation Center website, June 2020

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CMS Innovation Center’s Range of Impact

Source: Innovation Center Report to Congress, December 2018

Over 967,000 health care providers and provider groups ² across the nation are participating in CMS Innovation Center programs

CMS Innovation Center models impact over 26M beneficiaries in all 50 states^{1, 2}

Beneficiaries touched^*

Providers participating*

¹ Includes CMS beneficiaries (i.e., individuals with coverage through Medicare FFS, Medicaid, both Medicare and Medicaid (as Medicare-Medicaid enrollees), CHIP, and Medicare Advantage) and individuals with private insurance, including in multi-payer models

² Figures as of December 2019

* Data represents only 2 years of CMMI impact not all affected beneficiaries and providers over the entire CMMI experience, to date

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Vision: What Is To Come Over the Next 10 Years

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Advancing Health Equity

• Develop new models and modify existing models to address health equity and social determinants of health;
• Increase the number of beneficiaries from underserved communities who receive care through value-based payment models by increasing the participation of Medicare and Medicaid providers who serve them;
• Evaluate models specifically for their impact on health equity and share data and “lessons learned” to inform future work; and
• Strengthen data collection and intersectional analyses for populations defined by demographic factors such as race, ethnicity, language, geography, disability, and sexual orientation/gender identity to identify gaps in care and develop interventions to address them.

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ACO Realizing Equity, Access, and Community Health (ACO REACH) Model �

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New Focus on Health Equity

To promote Health Equity and expand the availability of accountable care to underserved communities, ACO REACH includes the following provisions:

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New Focus on Health Equity (Continued)

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Thank You

• Contact Information: Dora.Hughes@cms.hhs.gov
• CMMI Resources: https://innovation.cms.gov/

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Disclaimers

This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services.

This presentation is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. Medicare policy changes frequently, and links to the source documents have been provided within the document for your reference.

The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide.

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Medicare Advantage & the Drive to Health Equity�

Prepared for National Hispanic Medical Association�March 25, 2022�

Who is Better Medicare Alliance?

• Better Medicare Alliance is the leading research and advocacy organization supporting Medicare Advantage.�
• We are a community of 170 Ally organizations from across the health care spectrum and more than 600,000 grassroots beneficiary advocates nationwide.�
• Together, we work to create a healthier future by growing and strengthening Medicare Advantage.

Medicare Advantage Today

28.5+ million enrollees

$1,113 average annual consumer savings for Latino beneficiaries as compared to FFS Medicare

94% beneficiary satisfaction rate��

99.9% of MA plans offering supplemental benefits in 2022

53% of Latino Medicare beneficiaries choose Medicare Advantage ��

Record-Setting 76% Support in Congress ��

Medicare Advantage is proportionally more racially and socio-economically diverse than FFS Medicare. Half of all MA beneficiaries live below 200% of the Federal Poverty Level.

CMS projects roughly 29.5 million Medicare Advantage enrollees by the end of the year

According to a June 2021 analysis of MCBS survey data from ATI Advisory.

According to a December 2021 survey of MA beneficiaries conducted by Morning Consult.

Vision, hearing, dental, and wellness coverage are the most commonly offered benefits. Meal benefits (offered by 69% of plans) are also on the rise, as are transportation benefits (50% of plans).

409 Members of Congress (346 in the House, 63 in the Senate) wrote to CMS expressing support for Medicare Advantage earlier this year – marking bipartisan supermajority support for MA.

Medicare Advantage & Latino Communities

• 53% of Latino Medicare beneficiaries choose enrollment in Medicare Advantage, as do 49% of Black Medicare beneficiaries (higher than the overall Medicare Advantage penetration rate of about 44%).�
• The share of minority Medicare beneficiaries choosing enrollment in Medicare Advantage jumped 125% between 2013 and 2019 according to research from Milliman.�
• Why?
• Possible explanations include:�

• Consumer Savings: $1,113 a year for Latino Medicare beneficiaries compared to FFS Medicare.
• Health Outcomes: Latino Medicare beneficiaries report being more likely to receive certain healthcare services (e.g., mammograms, flu shots, blood pressure screenings, cholesterol checks) in Medicare Advantage.
• Supplemental benefits: Medicare Advantage plans are increasingly offering supplemental benefits unavailable in FFS Medicare than can meet diverse beneficiaries’ unique health and social needs. �

CHART: June 2021 analysis from ATI Advisory showing Medicare Advantage enrollment rates by demographic

BMA Allies Addressing Social Determinants of Health

ABOVE: Many Medicare Advantage plans contract with local chapters of Meals on Wheels America to fulfill their meal benefits (now offered by 69% of MA plans), providing a powerful aid to seniors facing food insecurity.

RIGHT: Medicare Advantage is increasingly working with partners like Papa to combat social isolation. Papa sends vetted companions known as “Papa Pals” to provide social interaction and help. Beneficiaries with day-to-day tasks.

LEFT: For those simply needing to move their bodies and congregate with other seniors like them, Medicare Advantage often covers a free SilverSneakers membership that can be used for fitness classes at over 15,000 locations nationwide.

The Value of MA Supplemental Benefits in the Drive to Health Equity

• Supplemental benefits in Medicare Advantage are addressing seniors’ social risk factors, helping them maintain dignity and independence, and keeping them on the path to wellness.�
• In fact, a report from Milliman released last year found that the additional benefits available in Medicare Advantage, combined with lower cost-sharing compared to FFS Medicare, yield $32.5 billion in total added value each year for beneficiaries.

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ABOVE: NHMA’s Dr. Elena Rios speaks to the value of Medicare Advantage as a force for health equity in a January 2022 Health Affairs blog post.

Medicare Advantage & Medicaid

• Nearly a quarter (23%) of Medicare Advantage beneficiaries are dually eligible for Medicaid. Today Medicare Advantage enrolls a higher proportion of dual-eligible beneficiaries than FFS Medicare.

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• Research finds that dual-eligible beneficiaries in Medicare Advantage are more likely to report having a usual source of care (91 – 93% in Medicare Advantage, 86% in FFS Medicare). �
• They are also more likely to receive key preventive services including mammograms, flu shots, and blood cholesterol screenings.

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ABOVE: A December 2021 analysis conducted by ATI Advisory found that dual-eligible beneficiaries in Medicare Advantage were more likely to receive key preventive services.

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