Transcript Medicare Coordinated Care Demonstration

Medicare Coordinated
Care Demonstration
John Pilotte, Research Analyst
Office of Research, Development, and Information
Third National Disease Management Summit
May 13, 2003
MCCD Overview
BBA 1997 Mandated
Evaluate Care Coordination Models That
Improve Quality of Services Provided to
Chronically Ill Beneficiaries & Reduce Medicare
Expenditures
Budget Neutral
Report to Congress
Report To Congress
Statutorily Required
Biennial Upon Implementation
Evaluation of….
– Cost Effectiveness
– Quality of Health Care Services
– Beneficiary and Provider Satisfaction
If Successful, Secretary…
– Continue Projects
– Expand Projects
– Implement Beneficial Components
MCCD Milestones
Best
Practices
Report
March 2000
1st Report
to Congress
Spring 2004
15 Sites
Selected
January 2001
Phased Implementation
Solicitation
Issued
July 2000
OMB Waiver
Package
Approved
March 2002
Site Characteristics
14 States and Washington, D.C.
– Urban, Rural Mix
15 Sites
– 10 Provider Based & 3 Commercial Vendors
– 1 Joint Venture & 1 Retirement Community Site
Various Chronic Conditions
Range of Interventions
– Case Management, Disease Management
– Patient/Provider Education, Rx Management
– Technology, Rx Drug Coverage
Study Design
Randomized Study
– Treatment Group
– Control Group
– Informed Consent
Required
49%
51%
343 Minimum Treatment
Group Enrollment
Enrolled to Date
– 10,000 in Treatment &
Control Groups
Treatment
Control
Percent of Beneficiaries
Enrollment Progressing Across Sites
88%
100%
65%
5 Sites
10 Sites
15 Sites
Observations
Operations vs. Research
All Health Care Is Local
Enrollment Challenges
– Beneficiary & Provider Outreach
Medicare FFS System Learning Curve
– Eligibility Verification, Enrollment Process, Claims
Persistence, Flexibility & Adaptability
CMS DM Demonstrations
Medicare Coordinated Care Demonstration
– Cindy Mason, Project Director -- [email protected]
BIPA Disease Management Demonstration
– Don Sherwood, Project Officer -- [email protected]
Capitated Disease Management Demonstration
– Ray Wedgeworth, Project Director -- [email protected]
ESRD Disease Management Demonstration
– Sid Mazumdar, Project Officer – [email protected]
CMS Demonstrations Web Page
http://www.cms.hhs.gov/healthplans/research