For example, studies  show that immunizations against influenza can prevent thousands of  hospitalizations and deaths each year among those age 65 and older. Many Medicare beneficiaries did not receive recommended preventive  services, such as influenza and pneumonia immunizations. 1). In CMS’s Medicare  Current Beneficiary Survey of 2000, however, about 30 percent of  Medicare beneficiaries did not receive an influenza vaccination, and 37  percent had never had a pneumonia vaccination. Many Beneficiaries May Be Unaware of Their Risk for Health Conditions That Preventive Care Is Meant to Detect

Many Medicare beneficiaries may not know that they are at risk for health  conditions that preventive care could detect—strong evidence that they  may not be receiving the full range of recommended preventive services.For example, data from CDC’s NHANES for 1999–2000 show that, of  beneficiaries participating in this nationally representative survey who had  a physical examination and were found to have elevated blood pressure  readings at the time of the examination, 32 percent reported that no  physician or other health professional had ever told them about the  condition. Projected  nationally, this percentage translates into 2.1 million Medicare  beneficiaries (see fig. Medicare + Choice Plans Reviewed Assess Health Risks Using Varying Approaches

The Medicare + Choice plans we reviewed vary in their specific strategies  for delivering preventive services, but several common themes emerge  from their efforts. New Ways to Improve the Provision of Preventive Services within Medicare’s Fee-for-Service Program Are Promising but Untested

Several options have been suggested for improving the provision of  preventive services within Medicare’s fee-for-service program. Following up on the study’s findings, CMS has begun designing a fee-for- service-focused demonstration project, called the Medicare Senior Risk  Reduction Program, to identify health risks and follow up with preventive  services provided by means other than physician visits. Perhaps of most concern, nearly one-third of beneficiaries  who were screened and identified as having elevated blood pressure or  high cholesterol measures in a nationally representative survey had not  previously been told by their physicians or other health providers that they  had these conditions. All plans we contacted had a means to  identify health risks, to provide feedback on risks to patients or their  physicians, and to follow up with interventions to reduce those risks. But  the follow-up programs, approaches, and priorities differed among the  plans we contacted, and few had evaluated their approaches in a manner  that would indicate whether these programs could, without significantly  increasing costs, improve health outcomes for Medicare beneficiaries. Appendix I: Scope and Methodology

Because no single source contained all the information we needed to  assess the extent to which Medicare beneficiaries receive preventive  services through existing physician visits, we used data from four national  health surveys: three conducted by the Centers for Disease Control and  Prevention (CDC) and one conducted by the Centers for Medicare &  Medicaid Services (CMS) (see table 2). To describe the preventive care approaches of Medicare + Choice plans,  we consulted with national experts and officials from the American  Association of Health Plans and chose five plans considered to have  innovative preventive care programs. We also interviewed Department of Health and Human Services and CMS  officials and reviewed documents on planned and present CMS  demonstrations related to preventive services.
Why GAO Did This Study

Medicare, the federal health program insuring almost 35 million beneficiaries age 65 and older, covers certain preventive services, such as flu shots and mammograms. Most beneficiaries receive care through Medicare's fee-for-service program, under which they generally receive these services as part of visits to the doctor for specific illnesses or conditions. Other beneficiaries receive services under Medicare's managed care program, called Medicare + Choice. GAO was asked to determine (1) the extent to which beneficiaries received recommended preventive services through existing visits, (2) whether approaches used by Medicare + Choice plans provide insight for improving delivery of preventive care services for fee-for-service beneficiaries, and (3) what the Centers for Medicare & Medicaid Services (CMS) is doing to explore suggested options for delivering preventive care to fee-for-service beneficiaries. GAO's work included analyzing data from four national health surveys and reviewing five Medicare + Choice plans considered to have innovative approaches to delivering preventive services. GAO also interviewed Department of Health and Human Services (HHS) and CMS officials and reviewed documents on CMS demonstrations related to preventive services.

What GAO Found

Most Medicare beneficiaries receive some preventive services through their visits to physicians, but relatively few receive the full range of preventive services available. Survey data showed, for example, that in 2000 about 30 percent of beneficiaries did not receive a flu shot, and 37 percent had never been vaccinated against pneumonia. Moreover, many Medicare beneficiaries are apparently unaware that they may have conditions that preventive services are meant to detect. For example, in a 1999-2000 nationally representative survey during which people received physical examinations, nearly one-third of those age 65 and older who were found to have high cholesterol measurements said they had not previously been told by a physician or other health professional that they had high cholesterol. Projected nationally, this percentage could represent 2.1 million people. No clear "best practice" approach to delivering preventive care stands out among the innovative Medicare + Choice plans GAO studied. All five plans identify health risks, provide feedback on risks to patients or their physicians, and follow up to reduce those risks. But their follow-up programs, approaches, and priorities differ, and little is known about the effectiveness of these efforts for the Medicare-age population. CMS has begun the development work to design a project evaluating the use of individual assessments of health risks, followed by counseling and other services, as a way to improve preventive care delivery. Another suggested approach--adding a routine physical examination benefit to Medicare's fee-for-service program--could provide more opportunities, but at increased cost and without guarantee that preventive services would actually be provided to Medicare beneficiaries.