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Coordinating Care for Medicare Fee-For-Service Beneficiaries
Contact: Randall Brown, (609) 275-2393, or Cheryl Pedersen, (609) 275-2258
PRINCETON, N.J. (April 11, 2007)—One of Medicare's biggest long-term fiscal challenges is controlling the cost of care for beneficiaries with chronic illnesses, such as heart disease and diabetes. A new report from Mathematica Policy Research, Inc., synthesizes findings from the first two years of the Medicare Coordinated Care Demonstration, 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. The publication was the source for a recent congressional report.
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. Findings include program-specific estimates of impacts on survey-based measures of patients' health status, knowledge, behavior, satisfaction with their health care, and quality of life, as well as impacts on patients' Medicare service use, expenditures, and quality of care received. The study also includes a qualitative assessment of the strengths and weaknesses of each program.
Mathematica's study, the largest random assignment study to date of disease management/case management programs, is examining whether programs meet their goals of reducing costs, improving quality of care, and improving patient satisfaction with care. The 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.
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 promising results for reducing costs or improving quality.
“It is too soon to expect impacts on some of these outcomes, and sample sizes for some programs are small,” said Randall Brown, lead author of the report and vice president and director of N.J. health research at Mathematica. “Final results covering the full four-year evaluation period will provide more definitive evidence of program effects.”
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 has since extended the end dates for 11 of the programs until 2008, when the final results of the evaluation will be complete.
“The Evaluation of the Medicare Coordinated Care Demonstration: Findings for the First Two Years,” by Brown, Deborah Peikes, Arnold Chen, Judy Ng, Jennifer Schore, and Clara Soh is on the web at www.mathematica-mpr.com/publications/redirect_pubsdb.asp?strSite=pdfs/mccdfirsttwoyrs.pdf . Printed copies are available from Publications, (609) 275-2350.
Mathematica®, a nonpartisan firm, conducts policy research and surveys for federal and state governments, foundations, and private-sector clients. The employee-owned company, with offices in Princeton, N.J., Washington, D.C., and Cambridge, Mass., has conducted some of the most important studies of health care, disability, early childhood policies, welfare, education, employment, and nutrition programs in the U.S. Mathematica strives to improve public well-being by bringing the highest standards of quality, objectivity, and excellence to bear on the provision of information collection and analysis to its clients.