A stronger, more sustainable Medicare

OPINION:

As a clinician who has worked to transform care from the inner cities to rural counties, I know we cannot meaningfully advance health for our communities without addressing their unique needs and circumstances. We must look at everything we do through the lens of health equity, because when the system doesn’t work, it’s those individuals with complex health and social needs who fall through the cracks.

Since 1965, Medicare has been the backbone of our modern health care system. Throughout its history, Medicare has led transformation for quality, affordable health care. Today, more than 63 million Americans rely on Medicare through Traditional Medicare and Medicare Advantage to provide health and financial security. It plays a central role in the Biden-Harris administration’s vision for the Centers for Medicare & Medicaid Services (CMS) to advance health equity; expand access to affordable coverage and care; drive high quality, person-centered care; and promote affordability and the sustainability of the Medicare trust funds.

Through the Medicare program, CMS is working to best serve the older Americans and people with disabilities that rely on Medicare for their health care coverage.

Expanding Access to Affordable Health Coverage and Care

Since its inception, Medicare has guaranteed quality health care for older Americans and people with disabilities. As we look ahead, there are several ways to expand access to needed services and treatments. For one, Medicare plays a crucial role in addressing the opioid epidemic, and we are committed to making treatment easier to access and more affordable while also working with providers to expand non-opioid pain management services. In addition, CMS will operationalize learnings from recent emergencies and disasters, such as the pandemic and the tornadoes that ripped through the South, to continue to improve timely access to care. And, we will continue to modernize payment policies to reflect innovations and changes in medical practice.

Advancing Health Equity

To advance health equity, Medicare is actively implementing policies that address inequities in care. For example, people with Medicare in need of behavioral health care services can now access services through audio-only telehealth if the patient does not have access to video, such as those who live in rural areas without access to broadband internet. Last fall, we also announced that following Congressional action, Medicare is funding additional medical residency positions in hospitals serving rural and underserved communities one of the largest increases in partially Medicare-funded residency slots in a decade because we know that health care providers are more likely to serve in the communities in which they train. Medicare is also exploring how to better support providers in rural and underserved communities as part of the Medicare Shared Savings Program.

Driving High Quality, Person-Centered Care

Over the last decade, Medicare accelerated participation in care models that reward higher quality care, smarter spending, and improved health outcomes. The promise of these care models has become even more evident recently. Many health care providers participating in the Medicare Shared Savings Program and the Next Generation Accountable Care Organization model were able to work quickly to provide the team-based services needed to address the full spectrum of issues arising from the pandemic. They were able to transition to telehealth and provide care in innovative ways to ensure needed access. They’ve shown us that better care coordination and providing care not just within the four walls of a hospital, but across the unique experiences of a person, are key to keeping people healthy. Strong accountable care programs are part of the larger strategy to ensure that people with Traditional Medicare have access to high quality, equitable care that meets their needs.

Promoting Affordability and Sustainability

CMS will work to ensure that Medicare remains affordable for people and sustainable for future generations. We have proposed increased transparency at the pharmacy for drug prices in the Part D program, which would lower out of pocket drug costs for people with Medicare Part D. We are looking for ways to ensure that we are getting the most out of every Medicare dollar by continuing to improve payment accuracy, and addressing fraud, waste, and abuse.

Engaging Our Partners and the Communities We Serve

All of this work has a common theme: working together to put people with Medicare coverage at the center of all that we do. We want to hear ideas from and partner with all of the numerous stakeholders who seek to drive meaningful change in the health care system. Let’s look to the work ahead together.

• Dr. Meena Seshamani, M.D., Ph.D., is the Deputy Administrator and Director of Center for Medicare. Prior to her nomination by President Biden, she designed and implemented population health and value-based care initiatives as Vice President of Clinical Care Transformation at MedStar Health. She also served as Director of the Office of Health Reform at the U.S. Department of Health and Human Services, where she drove strategy and led implementation of the Affordable Care Act. Dr. Seshamani completed her residency training in Otolaryngology-Head and Neck Surgery, has a PhD in Health Economics, and has practiced as a head and neck surgeon.