Panel, Fireside Chat
Reimagining Medicare for Longer Lives
Milken InstituteJoanne Kenen, Efrem Castillo, Nancy-Ann DeParle, Terry Fulmer, Darilyn Moyer, John, Saira, Corinne Purtill
- The outlook projects a gradual transition from an acute care model to a chronic disease system, characterized by a growing burden of multiple diseases over extended lifespans, with a historical spending growth rate of 7-8% per person (2000-2010) expected to slow to 1.5% annually.
- Demographic projections indicate a life expectancy of 75 years for those born in 2000, with white males reaching Medicare age anticipated to live another 16 years, necessitating a shift toward managing populations living 20 years longer with an average of five diseases.
- Healthcare delivery is expected to evolve through the reliable application of the 4Ms framework (what matters, mentation, medication, mobility), with a grant to Case Western aiming to integrate this into Epic EHRs across 5,000 CVS MinuteClinics and a goal for 100 new health systems to join the Age-Friendly Health System Initiative.
- Commercial and government entities anticipate leveraging structural changes to improve outcomes, including the Aetna and CVS merger utilizing 30,000 clinicians and 10,000 front doors to reduce emergency visits, and the STARS program targeting higher screening rates for diseases like colon cancer.
- Legislative and policy trends point toward a bipartisan consensus prioritizing quality over quantity, moving Medicare away from illness diagnosis to home-based care, with discussions regarding a fix for the Medicare Hospital Trust Fund solvency expected by 2024, despite historical congressional inaction until eight years out from a crisis.
- Systemic challenges include the current sickness-oriented model lacking reliability compared to pockets of excellence, the historical failure of the CLASS Act for long-term care, and the expectation that siloed aging and social services will eventually be viewed as obsolete.
- Future expectations involve a rise in senior advocacy driven by smarter, more active populations, with private sector experiments anticipated to determine the viability of paying for weight loss programs versus surgery, while specific populations may be targeted through the Inflation Reduction Act to assist with budget scoring.