title: Results of the Medicare Health Support disease-management pilot program.
abstract: BACKGROUND
  In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program.
  
  
  METHODS
  The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries.
  
  
  RESULTS
  The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures.
  
  
  CONCLUSIONS
  In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.
authors: RTI International, Washington, DC 20005, USA. nmccall@rti.org
authors: Nancy
authors: N
authors: McCall
authors: Jerry
authors: J
authors: Cromwell
mesh_terms: D002908:Chronic Disease / Q000451:nursing; D017046:Cost Savings; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics*; D005251:Fees, Medical; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D006278:Medicare / Q000191:economics*; D010865:Pilot Projects; D011787:Quality of Health Care; D014481:United States