Medicare Coordinated Care Demonstration John Pilotte Research Analyst

Medicare Coordinated Care Demonstration John Pilotte, Research Analyst Office of Research, Development, and Information Third National Disease Management Summit May 13, 2003

MCCD Overview BBA 1997 Mandated Evaluate Care Coordination Models That Improve Quality of Services Provided to Chronically Ill Beneficiaries & Reduce Medicare Expenditures Budget Neutral Report to Congress

Report To Congress Statutorily Required Biennial Upon Implementation Evaluation of…. – Cost Effectiveness – Quality of Health Care Services – Beneficiary and Provider Satisfaction If Successful, Secretary… – Continue Projects – Expand Projects – Implement Beneficial Components

Tra inin g lop 1 st Report to Congress Spring 2004 Site Wa ive r. D eve 15 Sites Selected January 2001 ges han s. C tem Sys got Ne Solicitation Issued July 2000 iati on Phased Implementation Site Best Practices Report March 2000 me nt MCCD Milestones OMB Waiver Package Approved March 2002

Site Characteristics 14 States and Washington, D. C. – Urban, Rural Mix 15 Sites – 10 Provider Based & 3 Commercial Vendors – 1 Joint Venture & 1 Retirement Community Site Various Chronic Conditions Range of Interventions – Case Management, Disease Management – Patient/Provider Education, Rx Management – Technology, Rx Drug Coverage

Study Design Randomized Study – Treatment Group – Control Group – Informed Consent Required 343 Minimum Treatment Group Enrollment Enrolled to Date – 10, 000 in Treatment & Control Groups

Enrollment Progressing Across Sites

Observations Operations vs. Research All Health Care Is Local Enrollment Challenges – Beneficiary & Provider Outreach Medicare FFS System Learning Curve – Eligibility Verification, Enrollment Process, Claims Persistence, Flexibility & Adaptability

CMS DM Demonstrations Medicare Coordinated Care Demonstration – Cindy Mason, Project Director -CMason 1@cms. hhs. gov BIPA Disease Management Demonstration – Don Sherwood, Project Officer -JSherwood@cms. hhs. gov Capitated Disease Management Demonstration – Ray Wedgeworth, Project Director -RWedgeworth@cms. hhs. gov ESRD Disease Management Demonstration – Sid Mazumdar, Project Officer –

CMS Demonstrations Web Page http: //www. cms. hhs. gov/healthplans/research