The Centers for Medicare & Medicaid Services (CMS) is calling for a renewed national commitment to value-based care based on Medicare claims data that provides
an early snapshot of the impact of the coronavirus disease 2019 (COVID-19) pandemic on the Medicare population. The data shows that older Americans and those with
chronic health conditions are at the highest risk for COVID-19 and confirms long-understood disparities in health outcomes for racial and ethnic minority groups
and among low-income populations.
“The disparities in the data reflect longstanding challenges facing minority communities and low income older adults, many of whom face structural
challenges to their health that go far beyond what is traditionally considered ‘medical’,” said CMS Administrator Seema Verma. “Now more
than ever, it is clear that our fee-for-service system is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a
doctor’s office. The transition to a value-based system has never been so urgent. When implemented effectively, it encourages clinicians to care for the
whole person and address the social risk factors that are so critical for our beneficiaries’ quality of life.”
New data show that more than 325,000 Medicare beneficiaries had a diagnosis of COVID-19 between January 1 and May 16, 2020. This translates to 518 COVID-19 cases
per 100,000 Medicare beneficiaries. The data also indicate that nearly 110,000 Medicare beneficiaries were hospitalized for COVID-19-releated treatment, which
equals 175 COVID-19 hospitalizations per 100,000 Medicare beneficiaries. Blacks were hospitalized with COVID-19 at a rate nearly four times higher than whites.
The disparities presented in the snapshot go beyond race/ethnicity and suggest the impact of social determinants of health, particularly socio-economic status.
Given the complexity of these disparities, any solution requires a multi-sectoral approach that includes federal, state, and local governments, community-based
organizations, and private industry. One piece of this is the increased implementation of a value-based system that rewards providers for keeping patients healthy
and gives consumers the information about disease prevention and outcomes needed to help make healthcare choices on the basis of quality. Additionally, CMS is
encouraging states to double down on efforts to protect low income seniors and look at the data and determine what resources are available, both locally and
federally, to improve this disparity of health outcomes.
For more information on the Medicare COVID-19 data, click here.