Disease Management for Chronically Ill Beneficiaries in Traditional Medicare

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Disease Management for Chronically Ill
Beneficiaries in Traditional Medicare
David M. Bott, Mary C. Kapp, Lorraine B.
Johnson, Linda M. Magno
January 6, 2008
Office of Research, Development and Information
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DM in Medicare FFS since 1999

• 7 demonstration projects
• with 2 to 8 years experience
• in 22 states
• operating 35 programs
• involving 300,000 beneficiaries
• With over 750 million dollars exposed pending
  financial reconciliation and recoupment

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Disease management is an intuitively appealing
approach to helping patients manage their chronic
conditions between office visits and avoid the
acute exacerbations that lead to hospitalization.
There is always an easy solution to every human
problemneat, plausible, and wrong. H.L.
Mencken
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No Dramatic Success

• Little improvement in
• compliance with evidence-based care,
• satisfaction for providers or beneficiaries,
• patient behavior change
• Limited savings
• little impact on expenditures
• generally less than DM fees

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Looking at what worked

• 7 of 35 programs
• almost paid for themselves
• were extended (since submission)
• No single program or intervention characteristic
  sufficient for determining success
• What worked varied
• Across organizations / interventions
• Across populations / conditions
• Across communities

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What Next?

• Extensions of current programs
• Are existing positive results sustainable?
• Can the programs be replicated?
• What elements work under what conditions?
• Study chronically ill beneficiaries
• Other Medicare demonstrations
• Senior Risk Reduction
• Medical Home