Medicare Makes Awards For Senior Risk Reduction Demonstration As Part Of Focus On Prevention, USA

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 19 Dec 2007 - 3:00 PDT

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The Centers for Medicare & Medicaid Services (CMS) announced awards for the Medicare Senior Risk Reduction Demonstration, seeking ways to promote health and wellness for seniors.

The demonstration will evaluate whether health promotion and disease prevention programs currently offered by private insurers and employers can be delivered by Medicare to encourage beneficiaries to engage in healthy lifestyles and practices that can help them maintain and improve their health, and reduce the need for health care services for preventable illnesses, injuries, or complications.

"We want to find ways to help Medicare beneficiaries identify their health risks, including risk factors for diseases they might not know they have, and provide them with information and support they need to proactively take better care of their health," said CMS Acting Administrator Kerry Weems.

The demonstration will address multiple health risk factors that contribute to chronic diseases, including physical inactivity, obesity, smoking, depression, high blood pressure, high cholesterol, and high blood sugar, as well as under-use of Medicare's preventive benefits.

Taking a comprehensive approach to health promotion and wellness has been shown to be cost effective in corporate settings, and the demonstration will try to learn if it works as well for the Medicare population.

Unlike CMS's disease management demonstrations, which have focused on helping severely chronically ill people to manage their diseases, this demonstration aims to focus on the other end of the health and illness spectrum, helping people who are reasonably well manage their health so they can delay the onset or exacerbations of chronic disease. CMS will randomly select beneficiaries under the age of 75 who may or may not have chronic diseases to invite to participate in this demonstration.

The five organizations selected through a competitive process are Health Dialog

Services Corporation, Focused Health Solutions, Health Partners Health Behavior Group, Pfizer Health Solutions Inc., and StayWell Health Management.

These organizations will provide health risk assessments followed by tailored feedback reports to help participants identify their health risks and inform them of ways they can improve their health. Participants will also receive health education and behavior change materials, and health coaching, provided on an ongoing basis using their preferred communication method, either through the mail, telephone, or internet.

Participants will also have the option of having information shared directly with their physicians. In addition, participants will receive referrals to national and local programs, such as physical activity, falls prevention, smoking cessation, and other types of health promotion programs, or if needed, referrals to their physician for recommended clinical preventive services.

"We all know that we should engage in healthy behaviors, like being physically active, eating a nutritious diet, and not smoking," Weems said. "Sometimes we need information and support to help us do the right things. The Medicare Senior Risk Reduction Demonstration will provide tailored information and support to beneficiaries, helping them to take better care of themselves so they can maintain their health and independence."

Approximately 85,000 fee-for-service Medicare beneficiaries randomly selected from across the country will be invited to participate in the three-year demonstration, 17,000 per demonstration organization.

The demonstration is unique in that it will also provide the Department of Health and Human Services the opportunity to examine the ability of its Aging and Disability Resource Centers, co-administered by CMS and the Administration on Aging, to link beneficiaries to health promotion programs in their communities.

While the Aging and Disability Resource Center grant program was originally initiated to support states in developing a one-stop shop to help consumers make decisions regarding long term care options in their communities, they have expanded their role to include providing information and assistance on other issues, including Medicare Part D. The five demonstration organizations will work with 10 Aging and Disability Resource Centers across the country to link beneficiaries to health promotion programs in their communities.

A one-year pilot to ensure that all processes are fully operational will begin in April 2008, with the demonstration beginning recruitment in October 2008.

Information on the Medicare Senior Risk Reduction Demonstration can be found here.

Centers for Medicare & Medicaid Services