Disease management for chronically ill beneficiaries in traditional Medicare.
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.
Bott
David M
DM
Centers for Medicare and Medicaid Services in Baltimore, Maryland, USA. david.bott@cms.hhs.gov
Kapp
Mary C
MC
Johnson
Lorraine B
LB
Magno
Linda M
LM
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