Managing the Medicare Boom

Jul 9, 2013
Baby Boomers entering the Medicare system with higher rates of obesity-related diseases require new adherence and MTM solutions to improve health decisions.
  • Medicare
  • Seniors
  • Caregivers

With an estimated 78 million people born during the baby boom, the sheer size of this generation has shaped too many social and cultural aspects of American life to count. And now, this generation is about to shape Medicare.

After increasing only about 1% per year for several years, in 2012 the number of Medicare beneficiaries grew 3.7% as the oldest members of the baby boomer generation turned 65. The U.S. Department of Health and Human Services estimates that a staggering 11,000 Baby Boomers become eligible for Medicare benefits each day.

Baby Boom Burden

Healthcare industry leaders have expressed much concern in recent years about the impending onslaught of beneficiaries into the federal healthcare system. Worries range from financial sustainability to concerns about our collective ability to care for this vast influx of Medicare beneficiaries.  

Compounding these concerns is evidence suggesting that this generation is not as healthy as previous generations of elderly Americans. One significant and soon-to-be expensive example is that baby boomers are more likely to report being obese and having health conditions associated with obesity.

Chronic diseases such as those associated with obesity often require the long-term use of specific medications. Recently reported in Express Scripts' Drug Trend Report, we looked at trends in baby boomers of various ages, pertaining to diabetes, high blood pressure and high cholesterol.

We evaluated medical diagnoses and prescription drug claims from Oct. 1, 2011, through Sept. 30, 2012, from a sample of Express Scripts members aged 49 to 67, in order to evaluate disease prevalence and prescription drug use.

Prevalence of disease by baby boomer

The research suggests an alarming trend with serious implications for the solvency of the Medicare system: the prevalence of each of the three conditions increases steadily with age.

Managing the Boom

Although the prevalence of chronic disease in older adults clearly presents heightened challenges for the Medicare program, the good news is that chronic diseases can be managed through improved patient behavior, lifestyle modifications and adherence to prescription medications. 

For instance, Express Scripts' ScreenRx® program has been tailored for the Medicare population. In this market segment, ScreenRx® has a unique effectiveness through a proprietary, Medicare-specific predictive model that identifies seniors who are at future risk of nonadherence, and then tailors support to help them overcome behavioral, clinical, and financial barriers to adherence and keep them on track. 

Medication Therapy Management (MTM) programs also play an important role in identifying and assisting beneficiaries at risk for gaps in care. However, only a small percentage of the Medicare Part D population are eligible for MTM according to criteria established by the Centers for Medicare and Medicaid (CMS). Express Scripts’ Expanded MTM program applies Health Decision ScienceTM to leverage behavioral science, clinical specialization, and use of actionable data to:

  • Target additional members at risk for gaps in care
  • Engage beneficiaries and prescribers 
  • Issue clinical alerts
  • Conduct medication reviews and implement tailored interventions.

These chronic diseases are also getting attention through the Medicare CMS Star Ratings program and our Expanded MTM program and other advanced clinical solutions focus specifically on these Star measures.

When it comes to chronic disease, even moderate improvements to lifestyle and medication adherence can lead to better outcomes and reduced costs. At Express Scripts, we keep working on the solutions that can help Baby Boomers and their health plans make those better decisions.

comments powered by Disqus