Lowering Medicare Costs by Keeping Seniors Healthy

Recognizing that raising premiums and cutting benefits aren’t the only ways to deal with the growing cost of Medicare, U.S. Senators Rob Portman (R-Ohio) and Ron Wyden (D-Ore.) introduced legislation that experts say could save Medicare billions by helping seniors get and stay healthy.

The Medicare “Better Health Rewards” program is a 100% voluntary program designed to help Medicare beneficiaries get and stay healthy by giving participating seniors achievable goals, a plan to reach them and incentives to keep motivated.  It is the first proposal to offer financial rewards for reaching health care goals.  Those rewards will be paid entirely by savings generated by seniors getting healthy and using less health care services.  In other words, participating seniors who save Medicare money will be given an opportunity to share in the savings.

Medicare Better Health Rewards is a three-year wellness program that uses the annual wellness visit Medicare already pays for to ascertain and measure improvements in six key areas of health: tobacco usage, body mass index, diabetes indicators, blood pressure, cholesterol and up-to-date vaccinations and screenings.  These areas have been identified as leading predictors of future health challenges.

In the first year, Medicare beneficiaries who choose to participate in the program will be assessed in each of these areas and then work with their doctor to develop a plan to bring their indicators into a healthier range.  The senior’s progress will be measured during subsequent wellness visits in years two and three of the program.  At those visits progress will be recognized for achieving and maintaining their targets in each of the key indicators.  As added motivation to stick with the program, seniors earning 20 or more points will be eligible for a “Better Health Reward” paid for by the program’s savings.

Under the program, the Centers for Medicare and Medicaid Services (CMS) will calculate savings by deducting the actual cost of seniors enrolled in the program from the total projected costs of those participating absent the program.

Portman's Better Health Rewards Bill Wins Support of Ohio Department of Health

The Ohio Department of Health (ODH) is backing U.S. Sen. Rob Portman’s (R-Ohio) recently introduced Medicare Better Health Rewards Bill due to its proactive, unique approach of improving the health of Medicare beneficiaries. The legislation would develop a 100% voluntary program to help Medicare beneficiaries get and stay healthy by giving participants achievable goals, a plan to reach them and incentives to keep motivated.

“The Medicare Better Health Rewards Program … is a unique program that will be one of the first to reward patients, in this case Medicare beneficiaries, for playing an active role in improving and maintaining their health,” said ODH Director Theodore Wymyslo in a letter to Portman. “Under this model, everyone wins … I am very proud of the success that this type of program has achieved at the Cleveland Clinic and am excited that your legislation proposes to expand this idea nationwide.”

Statements and Letters of Support

America's Health Insurance Plans (AHIP), Karen Ignagni, President and CEO

"...Our members support the goals of your legislation, its focus on encouraging healthy behavior among Medicare beneficiaries, and its emphasis on preventive health care services...Thank you again for addressing this critically important issue. Incentivizing healthy lifestyles and promoting the use of preventive health care services are goals we all share..." [Full text of letter: PDF, download]

Care Continuum Alliance

"...We applaud the important opportunities developed through this legislation that encourage Medicare beneficiaries to participate in a program emphasizing and rewarding wellness and health promotion...The Medicare Better Health Rewards Program Act of 2012 represents an important step for Congress in recognizing these achievements, bolstering further industry innovation and formally codifying the value of these programs..." [Full text of letter: PDF, download]

Cleveland Clinic, Toby Cosgrove, M.D., President and CEO

"Transforming the delivery of healthcare in this nation from 'sick' care to 'health' care takes commitment. I applaud the efforts of Senators Wyden and Portman to bring this issue to the forefront. We need to reduce the burden of chronic disease in the U.S., which accounts for 40 percent of premature deaths. Focusing on healthy behaviors will go a long way toward creating a healthier nation."

Cooper Clinic Preventive Medicine, Kenneth Cooper, M.D., MPH

"...Having worked in the field of preventive medicine and wellness for over 40 years, I know that any process that has the potential to substantially improve health while reducing the cost of Medicare could help all of us both personally and financially. So I, along with over 700 staff members of the Cooper Clinic/Cooper Aerobics Center in Dallas, strongly support this legislation and would like to have my representatives support such a measure..." [Full text of letter: PDF, download]

Healthcare Leadership Council

"...The Better Health Rewards Program legislation will align incentives to encourage Medicare beneficiaries to take greater advantage of existing prevention offering prescribed by the Patient Protection and Affordable Care Act (PPACA). With this bill, the new Medicare annual wellness visit becomes a powerful platform to empower patients to make lifestyle improvements that will result in better health outcomes..." [Full text of letter: PDF, download]

Healthcare Leadership Council, Mary R. Grealy, President

“Slowing the escalation in chronic disease is essential if we are to maintain affordable, accessible healthcare.  We can and must achieve better health among American seniors, many of whom have one or more chronic illnesses,” said Healthcare Leadership Council president Mary R. Grealy.  “Advancing wellness and disease prevention requires a combination of private sector innovation and thoughtful legislation such as the Medicare Better Health Rewards Program Act.  We’re making progress, but that progress needs to be accelerated.”

Deepak A. Kapoor, M.D., President of the Large Urology Group Practice Association and Chairman and CEO of Integrated Medical Professionals, PLLC

“We sincerely appreciate and strongly support Senator Wyden's bipartisan effort to ensure that Medicare beneficiaries continue to have access to life-saving screening for prostate cancer and other diseases through the proposed ‘Better Health Rewards’ program.  We also appreciate Dr. Underwood's work to illustrate how prostate cancer screening is vital to the health of underserved and minority populations, and how this program can help ensure access to those patients who are at greatest risk from this disease.”

Oregon Health & Science University (OHSU), Jeanette Mladenovic, M.D.

“Promoting creative ways to reduce chronic illness, to encourage physical activity, and to incentivize healthy nutrition, as suggested by the Medicare Better Health Rewards Program Act, makes common sense.  Wellness programs that promote healthy life styles are also an excellent way to keep seniors engaged which we know helps maintain cognitive function.”

Preventive Medicine Research Institute, Dean Ornish, M.D.

"The 'Better Health Rewards' bill that you and Senator Portman have introduced has great promise to lessen Medicare costs by decreasing the burden of chronic disease. As you know, health care costs have reached a tipping point. Providing significant incentives in this bill for Americans to develop healthier lifestyles is likely to provide better care at lower costs—and the only side-effects are good ones..."

Scott & White Healthcare

"Senator Wyden, thank you very much for taking the initiative in promoting a program that emphasizes incentives for patients to minimize or eliminate unhealthy behaviors from their lifestyle. This benefits not only the patients and their families, but our entire U.S. healthcare system. It recognizes that the patient should be actively engaged in their health and designing a reward system to recognize their active engagement is an appropriate health policy change for the Medicare program." [Full text of letter: PDF, download]

Additional Supporters Include:

  • Dr. Mehmet Oz
  • Dr. Mark Hyman, The UltraWellness Center
  • Joel Allison, President and CEO, Baylor Health Care System
  • Dr. Molly Coye, Chief Innovation Officer, UCLA Health System