CMS Medicare demos aim to better coordinate care

Projects will test disease management in a fee-for-service environment.

By Markian Hawryluk, AMNews staff. June 24, 2002.

Washington -- Medicare beneficiaries who wanted greater coordination of their care in the past usually could look only to private Medicare+Choice plans. Now officials and lawmakers are seeking to capture the same health and cost benefits that managed care plans realize for the rest of Medicare.

The Centers for Medicare & Medicaid Services recently announced 15 demonstration projects designed to test the application of disease management approaches for fee-for-service beneficiaries. The projects will target a wide range of conditions, including chronic heart failure; diabetes; cancer; and heart, liver and lung diseases. The programs just began enrolling patients.

CMS officials hope the demonstrations will provide the basis for expanding disease management principles to all of Medicare down the road and bring the program more in line with private health plan operations.

"The almost complete absence of disease management services in the traditional Medicare plan is another striking example of how outdated Medicare's benefit package has become," said Ruben King-Shaw, CMS deputy administrator and chief operating officer.

The principle behind disease management is to ensure that the treatment protocol prescribed by a physician is maintained between physician visits. By helping patients to better self-manage their care, the programs aim to reduce the complications of their chronic conditions.

The potential savings for the Medicare program is huge. According to Gerard Anderson, MD, professor of public health and medicine at Johns Hopkins University, about 78% of the Medicare population have at least one chronic condition, and 20% have five or more. [...]