Disease management for chronically ill beneficiaries in traditional medicare

Health Affairs

Volumn 28, Issue 1, 2009, Pages 86-98

  Bott, David M ^a   Kapp, Mary C ^a   Johnson, Lorraine B ^a   Magno, Linda M ^b  

^a CENTERS FOR MEDICARE AND MEDICAID SERVICES   (United States)

^b CMS Medicare Demonstrations Group

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; BEHAVIOR CHANGE; CHRONIC DISEASE; CHRONIC OBSTRUCTIVE LUNG DISEASE; CHRONIC PATIENT; CORONARY ARTERY DISEASE; COST CONTROL; DIABETES MELLITUS; HEALTH CARE COST; HEALTH CARE QUALITY; HEART FAILURE; HUMAN; MEDICARE; ORGANIZATION AND MANAGEMENT; PRIMARY HEALTH CARE; TOTAL QUALITY MANAGEMENT;

CENTERS FOR MEDICARE AND MEDICAID SERVICES (U.S.); CHRONIC DISEASE; DISEASE MANAGEMENT; FEE-FOR-SERVICE PLANS; HUMANS; UNITED STATES;

EID: 59449107849     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.28.1.86     Document Type: Article

References (29)

1. For a table with key characteristics of the twenty programs, with complete evaluations, see the Technical Appendix, online at http://content. healthaffairs.org/cgi/content/full/28/1/86/DC1.
2. DMAA: The Care Continuum Alliance, "DMAA Definition of Disease Management," 2004, http://www.dmaa.org/dm-definition.asp (accessed 24 June 2008);
3. and Christobel Selecky, chair, Government Affairs Committee, Disease Management Association of America (DMAA), Statement before the House Ways and Means Subcommittee on Health," 2005, http://waysandmeans.house.gov/ hearings.asp?formmode=view&id=401 (accessed 24 June 2008)
4. G.P. Mays, M. Au, and G. Claxton, "Convergence and Dissonance: Evolution in Private-Sector Approaches to Disease Management and Care Coordination," Health Affairs 26, no. 6 (2007): 1683-1691;
5. and S. Mattke, M. Seid, and S. Ma, "Evidence for the Effect of Disease Management: Is $1 Billion a Year a Good Investment?" American Journal of Managed Care 13, no. 12 (2007): 670-676.
6. Mays et al., "Convergence and Dissonance."
7. M. von Korff et al., "Collaborative Management of Chronic Illness," Annals of Internal Medicine 127, no. 12 (1997): 1097-1102.
8. See also Congressional Budget Office, An Analysis of the Literature on Disease Management Programs (Washington: CBO, 2004);
9. and Mattke et al., "Evidence for the Effect of Disease Management."
10. Selecky, Statement before the House Ways and Means Subcommittee on Health.
11. R. Stone, "The Disease Management Value Proposition" (Paper presented at the Eleventh Princeton Conference, "Managing Cost and Quality through the Health Care Delivery System," Princeton, New Jersey, 20-21 May 2004).
12. For a list of formal evaluation reports pending clearance for public release, internal monitoring reports not intended for public release, and selected examples fromthe collection of detailed analyses used as the basis for findings reported in this paper, see the online Technical Appendix, as in Note 1. The set of materials from which the examples are drawn could not be described in sufficient methodological detailwithin this policy-oriented paper.
13. A. Chen et al., Report to Congress on the Evaluation of Medicare Disease Management Programs (Baltimore: Centers for Medicare and Medicaid Services, 2008).
14. Ibid.
15. D. Peikes et al., Third Report to Congress on the Evaluation of Medicare Coordinated Care Demonstration (Baltimore: CMS, 2008). Table 5 on page 19 of this report is included in the online Technical Appendix, as in Note 1.
16. See also N. McCall et al., Evaluation of Phase I of Medicare Health Support (Formerly Voluntary Chronic Care Improvement) Pilot Program under Traditional Fee-for-Service Medicare: Report to Congress (Baltimore: CMS, 2007).
17. Peikes et al., Third Report to Congress.
18. H. Seow et al., "Isolation of Health Services Research from Practice and Policy: The Example of Chronic Heart Failure Management," Journal of the American Geriatrics Society 54, no. 3 (2006): 535-540.
19. R. Brown et al., Waiver Cost Estimates for the Medicare Coordinated Care Demonstration (Baltimore, Md.: CMS, 2001).
20. Also see R. Brown et al., Waiver Cost Estimates for the Medicare Disease Management Demonstration (Baltimore: CMS, 2003).
21. McCall et al., Evaluation of Phase I.
22. G. Kolata, "Tight Rein on Blood Sugar Yields No Heart Benefits," New York Times, 7 June 2008.
23. See also Action to Control Cardiovascular Risk in Diabetes Study Group et al., "Effects of Intensive Glucose Lowering in Type 2 Diabetes," New England Journal of Medicine 358, no. 24 (2008): 2545-2559;
24. and ADVANCE Collaborative Group et al., "Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes," New England Journal of Medicine 358, no. 24 (2008): 2560-2572. These two studies included Medicare beneficiaries.
25. Chen et al., Report to Congress on the Evaluation of Medicare Disease Management Programs.
26. O. Soran et al., "Randomized Clinical Trial of the Clinical Effects of Enhanced Heart Failure Monitoring Using a Computer-Based Telephonic Monitoring System in Older Minorities and Women," Journal of Cardiac Failure 13, no. 9 (2007): 793.
27. L.A. Aday, At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States, 2d ed. (San Francisco: Jossey-Bass, 2001). See the online Technical Appendix (as in Note 1) for documentation of the widespread experience by program staff that the Medicare FFS beneficiary population was sicker and poorer and had more sociocultural obstacles to the intervention than anticipated, despite the assurances of experience with this population in program application proposals.
28. S. Norris et al., "Health Care for Older Americans with Multiple Chronic Conditions: A Research Agenda," Journal of the American Geriatrics Society 56, no. 1 (2008): 149-159.
29. See the CMS Chronic Condition Data Warehouse home page at http://ccwdata.org.