title: Applying disease management strategies to Medicare.
abstract: Medicare coverage begins for many when they have already developed one or more chronic diseases, and it often pays for the latest and costliest phases. Population-based disease modeling, patient screening, and monitoring would be appropriate interventions for chronic renal disease. Patients who have not yet advanced to end-stage renal disease would benefit from management of diabetes and hypertension, avoidance of nephrotoxic substances, and better preparation for dialysis. Administrative support could take the form of clinical guidelines, physician-led multidisciplinary teams, integrated delivery systems, provider and patient education, and new information technologies. Medicare reflects the long-term public perspective, and thus should further this new direction by supporting education, reimbursing for prevention efforts and allied health services, encouraging efficiency, and monitoring cost and quality outcomes.
authors.affiliation: Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, MA 02454-9110, USA. tompkins1@brandeis.edu
authors.forename: C P
authors.initials: CP
authors.lastname: Tompkins
authors.forename: S
authors.initials: S
authors.lastname: Bhalotra
authors.forename: M
authors.initials: M
authors.lastname: Trisolini
authors.forename: S S
authors.initials: SS
authors.lastname: Wallack
authors.forename: S
authors.initials: S
authors.lastname: Rasgon
authors.forename: H
authors.initials: H
authors.lastname: Yeoh
mesh_terms: D018672:Community Health Planning / Q000458:organization & administration; D003363:Cost Control; D019468:Disease Management; D005544:Forecasting; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008134:Long-Term Care / Q000458:organization & administration; D008403:Mass Screening / Q000458:organization & administration; D006278:Medicare / Q000458:organization & administration*; D020380:Needs Assessment / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D014481:United States