Disease Management For Chronically Ill Beneficiaries In Traditional Medicare

Bott, David M.; Kapp, Mary C.; Johnson, Lorraine; Magno, Linda M.

doi:10.1377/hlthaff.28.1.86

Cited by 66 publications

(66 citation statements)

References 7 publications

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“…8,9 Most of these unsuccessful programs are telephone-only interventions that develop and update care plans to meet patients' needs, educate patients about self-care and medication…”

Section: -9mentioning

confidence: 99%

Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients

et al. 2012

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As policy makers seek to slow the growth in Medicare spending, they have appropriately focused attention on beneficiaries with multiple chronic conditions. Many care coordination and disease management programs designed to improve beneficiaries' care and reduce their need for hospitalizations have been tested, but few have been successful. This study, however, found that four of eleven programs that were part of the Medicare Coordinated Care Demonstration reduced hospitalizations by 8-33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches practiced by care coordinators in at least three of the four programs were as follows: supplementing telephone calls to patients with frequent in-person meetings; occasionally meeting in person with providers; acting as a communications hub for providers; delivering evidence-based education to patients; providing strong medication management; and providing timely and comprehensive transitional care after hospitalizations. When care management fees were included, the programs were essentially costneutral, but none of these programs generated net savings to Medicare. Our results suggest that incorporating these approaches into medical homes, accountable care organizations, and other policy initiatives could reduce hospitalizations and improve patients' lives. However, the approaches would save money only if care coordination fees were modest and organizations found cost-effective ways to deliver the interventions. M edicare's rapidly increasing costs have led policy makers to focus on improving the coordination of care for people with high-cost chronic conditions, for several reasons. First, beneficiaries with such conditions account for a disproportionately large share of total Medicare spending. 1 Second, ample opportunities exist to improve the care they receive.2-4 Studies of care coordination have noted the high proportion of preventable hospitalizations arising from inadequate or inappropriate care, poor patient adherence to recommended medication and selfcare regimens, and poor communication among the many providers whom a patient with chronic conditions typically sees. 2-9Despite the apparent opportunity to control spending by reducing the need for hospitalizations among such beneficiaries, several demonstrations by the Centers for Medicare and Medicaid Services (CMS) to test disease management and care coordination programs in fee-forservice Medicare have been largely unsuccessful. 8,9 Most of these unsuccessful programs are telephone-only interventions that develop and update care plans to meet patients' needs, educate patients about self-care and medication

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“…8,9 Most of these unsuccessful programs are telephone-only interventions that develop and update care plans to meet patients' needs, educate patients about self-care and medication…”

Section: -9mentioning

confidence: 99%

Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients

et al. 2012

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“…The impact of lowering A1c on medical costs is mixed. [36][37][38][39][40][41] The recently reported outcomes of the Medicare Health Support Disease Management Pilot Program, which enrolled more than 100,000 individuals with diabetes in the intervention and approximately 60,000 in the control group, showed no evident reduction in the utilization of acute care or the cost of care. 42 DSME is typically performed by diabetes educators and is a covered benefit by Medicare and many commercial payers.…”

Section: ■■ Discussionmentioning

confidence: 99%

Medical Claim Cost Impact of Improved Diabetes Control for Medicare and Commercially Insured Patients with Type 2 Diabetes

Fitch¹,

Pyenson²,

Iwasaki³

2013

JMCP

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BACKGROUND: Diabetes prevalence is increasing in the United States, yet the control of critical clinical metrics (e.g., hemoglobin A1c [A1c], blood pressure, and lipids) remains suboptimal. Lower A1c levels have been shown to be associated with lower diabetes complication rates, and reduced medical costs have been reported in individuals with diabetes who have improved glycemic control. While many studies have quantified the impact of A1c control on medical claim costs, this article provides new information on the cost and event impact of better control for all 3 metrics for the commercial population and Medicare population separately.

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“…Although an estimated 40% of chronically ill older adults live alone (Bott, Kapp, Johnson, & Magno, 2009), the majority of caregiver interventions are designed for the spouse or partner (usually an adult child) who lives with the older adult. While primary caregiver studies (those restricted to the spouse, adult child, or other informal caregiver who lives with the older adult) can provide important micro-level perspectives of chronic illness care, the paucity of intervention studies with the older adult's neighbors or friends as informal caregivers (who help with meals, medications, and transportation) and long-distance caregivers (who use a variety of strategies to coordinate care from afar) remains a limitation in chronic illness caregiving science.…”

Section: The Spouse Is Not the Only Caregivermentioning

confidence: 99%

Caring for Frail Older Adults: A Theoretical and Methodological Agenda

Davis

2012

Research in Gerontological Nursing

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Disease Management For Chronically Ill Beneficiaries In Traditional Medicare

Cited by 66 publications

References 7 publications

Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients

Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients

Medical Claim Cost Impact of Improved Diabetes Control for Medicare and Commercially Insured Patients with Type 2 Diabetes

Caring for Frail Older Adults: A Theoretical and Methodological Agenda

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