Evaluating the Medicare Coordinated Care Demonstration

The Medicare Coordinated Care Demonstration tested whether case management and disease management programs lowered costs and improved patient outcomes and well-being in the Medicare fee-for-service population. It aimed to improve health outcomes and reduce Medicare costs for chronically ill beneficiaries by encouraging adherence to self-care and medication regimens, as well as improving communication among physicians and between patients and physicians. In January 2002, the Centers for Medicare & Medicaid Services (CMS) selected 15 demonstration programs to participate in the evaluation, which it funded. Each program began enrolling beneficiaries between April and September 2002 and was authorized to operate for four years. CMS extended the end dates for 11 of the programs until 2008. Mathematica's study, the largest random assignment study to date of disease management/case management programs, examined whether the programs met their goals of reducing costs, improving quality of care, and improving patient satisfaction with care. It also included a qualitative assessment of the strengths and weaknesses of each program.

The final report to Congress synthesizes findings from more than four years of the demonstration programs’ operations, and provides the most comprehensive and rigorous estimates ever presented on the effectiveness of care coordination interventions in a Medicare fee-for-service setting. Only 2 of the 15 programs resulted in reduced hospital admissions, and none of the programs generated net savings. There were few effects on beneficiaries’ adherence to prescribed medication, diet, or exercise regimens. The report describes ways in which the more successful programs differed from the unsuccessful ones and concludes that programs with these features could generate savings for Medicare if implemented for a high risk target population.

View all publications from the study.

Searching for Best Practices in Coordinated Care  

The Medicare Coordinated Care Demonstration described above was based on findings from an earlier study for CMS to identify best practices in coordination of care. Best practice programs were defined as those most effective in reducing the need for expensive health care services by improving quality of patient care. We conducted a search for already implemented, effective care coordination programs, and a variety of case management, disease management, and geriatric evaluation and management programs submitted data in response. Other programs were identified from published literature. We then interviewed selected programs to identify common features of effective care coordination. To be considered, programs had to have strong, quantitative evidence of reducing hospital admissions or total medical costs. This requirement greatly limited the set of programs we could consider, but it ensured that our conclusions were drawn from data on programs that have been proved effective.

An issue brief on disease management options highlights issues for state Medicaid programs to to consider.

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