Have you seen the effects of chronic illness up close? Do you want to be part of a nationwide effort to help people with diabetes feel better every day? Primaris and CLAIM have joined the national Health for Life, an Everyone with Diabetes Counts initiative, and are seeking community partners to help teach diabetes self-management education classes in Missouri.
Diabetes is the most common cause of blindness, kidney failure and amputations in adults, as well as a leading cause of heart disease and stroke. People with diabetes spend 2.3 times more on health care costs than others without the disease. Primaris and CLAIM will provide training for individuals and community partners interested in improving the quality of life for persons with diabetes.
Diabetes Self-management Education (DSME) is a proven intervention for empowering persons with diabetes to take an active role in managing their disease. It has been shown that DSME classes significantly reduce serious complications such as heart disease, amputations of lower limbs, kidney failure and blindness
Primaris and CLAIM will provide the training and provide the tools and resources for no charge to help community partners deliver these classes in settings where neighbors, relatives and friends can benefit. Once trained, partners will run a six-week series of classes with activities and exercises that help people understand how to make better lifestyle choices.
Contact Dorothy Andrae at 800-735-6776 x209 for more information and training locations near you.
Join us in the fight against diabetes. Together, we can save lives.
CLAIM is Missouri’s State Health Insurance Assistance Program and has been serving Missourians since 1993. The CLAIM program is funded by the state and a federal grant and trains local volunteers to answer questions about Medicare. CLAIM exists solely to provide Medicare beneficiaries with free, unbiased counseling for their Medicare questions and issues.
Primaris Foundation provides the services for the CLAIM program through a contract with the Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP). Funding is provided by the Administration for Community Living with oversight by DIFP.
Primaris is a healthcare consulting firm that works with hospitals, physicians and nursing homes to drive better health outcomes, improved patient experiences and reduced costs. For more information, visit www.primaris.org and follow @primaris_health.
After three years of operations, the Centers for Medicare & Medicaid Services (CMS) today reported that the agency’s advanced analytics system, called the Fraud Prevention System, identified or prevented $820 million in inappropriate payments in the program’s first three years. The Fraud Prevention System uses predictive analytics to identify troublesome billing patterns and outlier claims for action, similar to systems used by credit card companies. The Fraud Prevention System identified or prevented $454 million in Calendar Year 2014 alone, a 10 to 1 return on investment.
“We are proving that in a modern health care system you can both fight fraud and avoid creating hassles for the vast majority of physicians who simply want to get paid for services rendered. The key is data,” said CMS Acting Administrator Andy Slavitt. “Very few investments have a 10:1 return on taxpayer money.”
The Fraud Prevention System was created in 2010 by the Small Business Jobs Act, and CMS has extensively used its tools, along with other new authorities made possible by the Affordable Care Act, to help protect Medicare Trust Funds and prevent fraudulent payments. For instance, last month Health & Human Services (HHS) and the Department of Justice announced the largest coordinated fraud takedown in history, resulting in charges against 243 individuals, including 46 doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings. Over the last five years, the administration’s efforts have resulted in more than $25 billion returned to the Medicare Trust Fund.
The Fraud Prevention System helps to identify questionable billing patterns in real time and can review past patterns that may indicate fraud. In one case, one of the system’s predictive models identified a questionable billing pattern at a provider for podiatry services that resulted in Medicare revoking the provider’s payments and referring the findings to law enforcement. The Fraud Prevention System also identified an ambulance provider for questionable trips allegedly made to a hospital. During the three years prior to the system alerting officials, the provider was paid more than $1.5 million for transporting more than 4,500 beneficiaries. A review of medical records found significant instances of insufficient or lack of documentation. CMS also revoked the provider’s Medicare enrollment and referred the results to law enforcement.
“The third year results of the Fraud Prevention System demonstrate our commitment to high-yield prevention activities and our progress in moving beyond the ‘pay and chase’ model,” said Dr. Shantanu Agrawal, CMS deputy administrator and director of the Center for Program Integrity. “We have learned a lot in the three years since the Fraud Prevention System began, and as we learn, we continue to become more sophisticated in detecting aberrant billing patterns and developing leads for investigations and action.”
In future years, CMS plans to expand the Fraud Prevention System and its algorithms to identify lower levels of non-compliant health care providers who would be better served by education or data transparency interventions.
For more information, please see the Report under “Guidance and Reports” at: http://www.cms.gov/About-CMS/Components/CPI/Center-for-program-integrity.html
Over the next 50 days, the Centers for Medicare & Medicaid Services will recognize the impact these two programs have had in transforming our nation’s health care system. By sharing daily facts and posts on Twitter (@cmsgov) and Medicaid.gov, CMS will highlight people, places, and progress that represent the Medicare and Medicaid programs as we know today.
“The 50th anniversary of Medicare and Medicaid provides an important opportunity for us to reflect on the critical role these programs have played in protecting the health and well-being of millions of families,” said Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services. “Today, Medicare and Medicaid are creating a health care system that is better, smarter, and healthier – setting standards for how care is delivered. As we take a moment to reflect on the past five decades, we must also look to the future and explore ways to strengthen and improve health care for future generations.”
On July 30, 1965, President Johnson signed legislation to establish Medicare for the elderly and Medicaid for low-income adults, children, pregnant women, and people with disabilities. Though Medicare and Medicaid started as basic health coverage programs for Americans, the programs have evolved over the years to provide more Americans with improved access to quality and affordable health care coverage. These programs have transformed the delivery of health care in the United States.
To commemorate this golden anniversary, CMS will engage in conversations with beneficiaries, providers, and health experts. We invite the public to participate in this celebration by sharing stories of how Medicare and Medicaid have made a difference. Stories can be shared at Medicare.gov/anniversary/share-your-story. In late July, regional CMS offices will host public events in addition to a national event in Washington, D.C.
Columbia, Mo. —CLAIM, the Missouri State Health Insurance Assistance Program, has been awarded an AmeriCorps grant for the fifth straight year. This year’s grant, totaling $94,674, will allow CLAIM to extend its reach to more Medicare enrollees across the state.
The CLAIM grant was part of the $4.2 million in funding announced Monday by Governor Jay Nixon for community programs and non-profit organizations across the state. The AmeriCorps members help the CLAIM program provide additional outreach to Medicare beneficiaries and recruit additional volunteers to provide education and outreach. Members also become expert counselors.
“We help more than 40,000 individuals each year understand their Medicare options,” said Carol Beahan, CLAIM Director. “The AmeriCorps grant will extend that reach by more than 20,000 individuals.”
Since Sept. 1, 2014, over 4,000 Medicare beneficiaries have been served, over 26,000 beneficiaries have been reached based on outreach programs and over 6,600 hours have been spent assisting those beneficiaries. CLAIM currently has 11 AmeriCorps volunteers.
Founded in 1993, CLAIM has helped Missourians save millions in out-of-pocket expenses by helping beneficiaries understand their Medicare benefits and by providing enrollment assistance.