title: Disease management for chronically ill beneficiaries in traditional Medicare.
abstract: We summarize the Centers for Medicare and Medicaid Services' (CMS's) experience with disease management (DM) in fee-for-service Medicare. Since 1999, the CMS has conducted seven DM demonstrations involving some 300,000 beneficiaries in thirty-five programs. Programs include provider-based, third-party, and hybrid models. Reducing costs sufficient to cover program fees has proved particularly challenging. Final evaluations on twenty programs found three with evidence of quality improvement at or near budget-neutrality, net of fees. Interim monitoring covering at least twenty-one months on the remaining fifteen programs suggests that four are close to covering their fees. Characteristics of the traditional Medicare program present a challenge to these DM models.
authors.affiliation: Centers for Medicare and Medicaid Services in Baltimore, Maryland, USA. david.bott@cms.hhs.gov
authors.forename: David M
authors.initials: DM
authors.lastname: Bott
authors.forename: Mary C
authors.initials: MC
authors.lastname: Kapp
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Johnson
authors.forename: Linda M
authors.initials: LM
authors.lastname: Magno
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D002908:Chronic Disease; D019468:Disease Management; D018588:Fee-for-Service Plans; D006801:Humans; D014481:United States