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CMS App to Drive Beneficiary Education About Plan Coverage

The What's Covered app from CMS will drive beneficiary education about Medicare covered services.

cms beneficiary education

By Sara Heath

- CMS has launched a new patient-facing app geared toward improving beneficiary education about basic Medicare plans.

The “What’s Covered” app will be available to patients with Original Medicare and comes as a part of the agency’s eMedicare program.

Specifically, patients and authorized caregivers can use What’s Covered to view the specific services included in basic Medicare plans. Such functionality may be useful in the doctor’s office or hospital when a clinician recommends a certain service. The patient can use the app to look up whether the service will be covered under their Original Medicare plan.

The What’s Covered app will also build upon the Blue Button 2.0 initiative, which CMS revamped in March 2018. The app will house the claims data patients have a right to access. Using APIs, patients may connect that data to third-party apps. This will make patient data access more valuable. Instead of just viewing their claims data, patients can use this data to improve their experiences with certain tools and with healthcare at large.

These developments are a part of the agency’s efforts to improve Medicare by making it more patient-centric, said CMS Administrator Seema Verma.

“eMedicare is one of several initiatives focused on modernizing Medicare and empowering patients with information they need to get the best value from their Medicare coverage,” Verma said in a statement. “President Trump is delivering on his commitment to Medicare by modernizing tools that deliver health information in the most convenient way possible. This new app is the next in a suite of products designed to give consumers more access and control over their Medicare information.”

Improvements to the Medicare program will be essential as the program sees an influx of patients with unprecedented needs.

The Medicare population is slated to increase by about 50 percent, from 54 million beneficiaries in 2015 to 80 million by 2030. These patients will have needs not yet seen in a Medicare population.

For example, this will be the first Medicare population that defies popular logic about older patients and technology use. Most of the new Medicare population is used to technology, have used it at least for their jobs, and may have even begun integrating it into their current healthcare management strategies.

In 2016, two-thirds of Medicare beneficiaries reported that they use the internet at least daily, CMS reported. This underscores the potential that mHealth apps have for beneficiary education and their likely warm reception.

At the same time, beneficiaries have a lot of questions about covered services. The Medicare website has over 15 million views on its webpages discussing covered services each year. The Medicare help line receives 3 million coverage-related calls annually.

Using technology in which patients have expressed interest to address common beneficiary questions may be an effective strategy for driving beneficiary education, CMS said.

The What’s Covered app comes as a part of the CMS eMedicare program. eMedicare, launched in 2018, aims to digitize the Medicare patient experience and help bring healthcare into the 21st Century.

“Since day one, President Trump has been committed to strengthening the Medicare program—eMedicare puts his leadership into action by giving Medicare beneficiaries a simpler, more intuitive customer experience,” Verma noted in October after unveiling the updated eMedicare website. “Our intent is not to replace traditional channels that beneficiaries trust and depend on, but to improve and enhance them with the emerging digital options to create a user-centered, seamless consumer experience.”

Other patient-facing tools in the eMedicare suite include:

  • Online decision support presenting patients with quality and price information
  • An out-of-pocket cost calculator that compares different Medicare plan details
  • Price transparency tools that allow patients to view national average costs for services and compare costs at different facilities
  • Webchats in Medicare Plan Finder
  • Streamlined user experience surveys

This newest tool, What’s Covered, is currently available on the Apple App Store and in Google Play.

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