NQF: From the Medicare Rights Center perspective, what do consumers worry about most, and how are you addressing these concerns?

JB: As expressed year after year on Medicare Rights’ national helpline, which fields nearly 20,000 questions annually from beneficiaries, family caregivers, and healthcare professionals, our clients are most often concerned about affording their care (including premiums and cost sharing), appealing denials of coverage, and navigating Medicare enrollment amidst complex rules and varied choices. Many of our advocacy efforts are designed to address these challenges head on. For example, our leading federal policy campaign is focused on smoothing enrollment transitions for those new to Medicare, and we are pursuing both legislative and administrative fixes to enhance notice and education, modernize enrollment periods, and more.

A relatively new area of focus for Medicare Rights involves health systems transformation occurring at both the federal and state levels that is intended to both lower healthcare costs and enhance care quality. Medicare Rights is actively working to ensure emerging payment and delivery system models are truly patient-centered and that consumers are fully educated and prepared to navigate new systems of care.

In New York, where Medicare Rights is based, the state is implementing several such care models, including value-based payment initiatives and the Fully Integrated Duals Advantage (FIDA) program, among others. Through these programs, we aim to inform new policies by incorporating the voice and experience of older adults and people with disabilities. Medicare Rights participates on stakeholder workgroups for value-based initiatives and leads a coalition that advocates on behalf of dual eligible beneficiaries with long-term care needs enrolled in FIDA.

NQF: Can you tell us more about the importance of your work on behalf of the 10 million Americans who are dually eligible to participate in Medicare and Medicaid?

JB: Dual eligible beneficiaries are among the most vulnerable and costly Medicare beneficiaries. We advance policies that ensure these individuals receive high-quality, cost-effective care. We also aim to ensure that Medicaid health system transformation—in the form of provider partnerships and other informal networks—does not hinder dual eligible individuals’ abilities to access their choice of fee-for-service Medicare providers.

Support for dual eligible beneficiaries is integral to our educational programs, including Medicare Interactive, an online resource that reaches 2 million Americans annually, as well as the technical assistance and support we provide to State Health Insurance Assistance Programs (SHIPs) across the country. Operating in every state and territory, SHIPs provide one-on-one counseling to people with Medicare and their families.

In addition, much of our work on behalf of dual eligible beneficiaries occurs through our state policy initiatives, with a focus on New York’s transformation of its Medicaid program. As the convening organization of the Coalition to Protect the Rights of New York's Dually Eligible, we are committed to improving Medicaid managed care programs that provide Medicare and Medicaid services for dual eligible individuals with long-term care needs.

NQF: What is the role of healthcare quality measurement in these efforts? How is the Medicare Rights Center involved in NQF’s Measure Applications Partnership?

JB: Through the implementation of the FIDA program in New York State and at the federal level with the CMS, Medicare Rights continually weighs in on policies related to the use of quality measures and ratings in efforts to better integrate care for dual eligible beneficiaries, namely through managed care plans. We look forward to bringing this expertise and our direct experience working with people who are covered by both Medicare and Medicaid to NQF’s Measure Applications Partnership (MAP) Dual Eligible Beneficiaries Workgroup.

NQF: How is NQF membership helping to advance Medicare Rights’ work?

JB: Medicare Rights recently joined NQF as a member because of our mutual commitment to using quality measurement to improve healthcare quality. We have participated in NQF forums to learn more about quality measurement, and we have benefited from presenting on NQF webinars about Medicare Rights’ work and our experiences counseling consumers and patients. For example, we were an invited guest on a webinar for NQF members to speak about common trends heard on our national helpline concerning affordability, denials and appeals, and Medicare enrollment. We look forward to deepening this relationship and our expertise in quality measurement through the MAP Dual Eligible Beneficiaries Workgroup.