Evaluating the Medicare Coordinated Care Demonstration

The Medicare Coordinated Care Demonstration is testing whether case management and disease management programs can lower costs and improve patient outcomes and well-being in the Medicare fee-for-service population. It aims 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. Mathematica's study, the largest random assignment study to date of disease management/case management programs, is examining whether the programs meet their goals of reducing costs, improving quality of care, and improving patient satisfaction with care. It also includes a qualitative assessment of the strengths and weaknesses of each program.

The latest report, which was the source for the most recent congressional report, focuses on program impacts over the first year after enrollment for beneficiaries who enrolled during the first year of operations, and over the first 25 months of operation for all enrollees. It synthesizes findings from the first two years noting that patients and physicians were generally very satisfied with the program, but few programs had statistically detectable effects on patients' behavior or use of Medicare services.

Major findings, at about one year after enrollment, include the following:

• None of the programs significantly improved adherence to diet, medication, exercise, or self-care regimens.
• Quality of care, whether measured with preventive care indicators, preventable hospitalizations, or a range of well-being indicators, was favorably affected by only two of the 15 programs (with different programs affecting different outcomes).
• Only one program had statistically significant reductions in hospitalizations, and none reduced costs.
• Hiring excellent staff and performing certain key functions well (e.g., improving communication and coordination, patient education) appear to be more important than a focus on improving provider performance, service arrangement, or having a strong information technology in determining whether a program had potentially promising results for reducing costs or improving quality.

CMS has since extended the end dates for 11 of the programs until 2008, when the final results of the evaluation will be complete and presented in a third report to Congress.

View publications from the study.

Searching for Best Practices in Coordinated Care  

The Medicare Coordinated Care Demonstration described above was based on findings form a preceding 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.

Back to Top