As part of its efforts to increase prevention on the part of Medicare beneficiaries, the Centers for Medicare and Medicaid Services (CMS) announced today that it has issued a solicitation to implement a health promotion and disease prevention program through the Medicare Senior Risk Reduction Demonstration.

The demonstration will determine whether health risk reduction programs that have been developed, tested, and shown to be effective in the private sector can be tailored to the Medicare program to help beneficiaries improve their health and thus reduce the need for health care services.

“Personal involvement and personal choices have a huge impact on health and health care,” said Mark B. McClellan, M.D., Ph.D., administrator of the Centers for Medicare and Medicaid Services (CMS), the agency that oversees the Medicare program. “The Senior Risk Reduction Demonstration will help us determine whether more intensive support can help our beneficiaries stay well and prevent complications from chronic diseases.”

As part of the MyHealth, MyMedicare initiative, CMS is working to help seniors improve their health by providing them with the information, resources, and support they need to make lifestyle changes and to get important preventive services.

“We have made a commitment to modernize Medicare and increase prevention efforts to reduce the burden of chronic conditions, but we can only achieve this goal through a partnership with seniors,” Dr. McClellan said. “Our goal is to improve health and lower health care costs by helping older Americans take steps to reduce their risk factors and take advantage of Medicare’s improved preventive coverage.”

Eighty-two percent of seniors have one chronic condition, and about 50 percent have two or more.   Seniors with these conditions have better outcomes with fewer costly complications when they are diagnosed early, and when they take lifestyle steps that are proven to improve their health. However, despite Medicare coverage, seniors are not taking advantage of preventive services and important screenings that can help detect diseases early. For example, Medicare data from 1998 through 2002 indicate that only about 45% of eligible beneficiaries had one claim for colorectal cancer screening during this five-year period, even though colorectal cancer is the second leading cause of cancer death in the U.S. and curable when detected early.

In the last two years, Medicare has added a variety of new preventive benefits to help seniors take better care of themselves.  These include the Welcome to Medicare exam, which provides education and counseling about important preventive services, including screening tests and shots, and referrals for other needed services for all new Medicare enrollees within their first six months of starting their Medicare Part B coverage.  Other preventive benefits include cardiovascular screening blood tests, diabetes screening, counseling to quit smoking, and glaucoma screening for Hispanic Americans age 65 or over.

However, millions of seniors have chronic conditions and do not know it, and are not treating them effectively, because they are not taking advantage of Medicare’s new preventive coverage. For example, approximately one in five Medicare beneficiaries have diabetes, but one-third of Medicare beneficiaries with diabetes do not even know they have this disease. Medicare covers diabetes self-management training, but many beneficiaries with this disease have not taken advantage of this benefit. Similarly, about 10% of seniors report that they smoke, but very few have taken advantage of Medicare coverage for smoking cessation counseling. 

The demonstration announced today will address multiple health risk factors that contribute to chronic diseases, including physical inactivity, obesity, smoking, depression, high blood pressure, high cholesterol, high blood sugar, and underused Medicare preventive benefits.   Taking a comprehensive approach to disease prevention and management has been shown to be cost effective in corporate settings.

“This is one more step toward paying for what we want:   more disease prevention and better care leading to lower health care costs,” added Dr. McClellan.  “This demonstration can support doctors and other health professionals by providing support in their efforts to help seniors make important changes, such as starting an exercise program and using recommended preventive care.”

CMS will select up to five existing health promotion, disease prevention, and risk reduction organizations to participate in this three-year demonstration.   Final award decisions should be made by spring 2007. 

Approximately 85,000 Medicare fee-for-service beneficiaries will be invited to participate in the demonstration. After completing a health risk assessment, participants will receive information tailored to their particular health risk factors, as well as referrals to community resources to help support them in making lifestyle changes. 

Information and support will be provided on an ongoing basis using the beneficiary’s preferred communication method, either through the mail, telephone, or internet. Beneficiaries will also have the option of having information shared directly with their physicians

The solicitation, which went on display today at the Office of the Federal Register, and additional information concerning the demonstration can be found on the CMS website at: http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/Senior_Risk_Reduction_Solicitation.pdf