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Evaluation of Medicare Health Support chronic disease pilot program.

Cromwell J, McCall N, Burton J - Health Care Financ Rev (2008)

Bottom Line: Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries.In this article, we present 6-month intervention results on beneficiary selection and participation rates, mortality rates, trends in hospitalizations, and success in achieving Medicare cost savings.Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization.

View Article: PubMed Central - PubMed

Affiliation: Research Triangle Institute International, Waltham, MA 02451, USA. jcromwell@rti.org

ABSTRACT
The Medicare Program is conducting a randomized trial of care management services among fee-for-service (FFS) beneficiaries called the Medicare Health Support (MHS) pilot program. Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries. In this article, we present 6-month intervention results on beneficiary selection and participation rates, mortality rates, trends in hospitalizations, and success in achieving Medicare cost savings. Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization.

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Related in: MedlinePlus

Proportion of Net Total Savings1 Required and Achieved Through Pilot's First 6 Months, by MHSO1 Percentages on top of light bars include required 5 percent Medicare claims savings plus monthly fee as a percentage of the comparison group's per beneficiary per month.NOTES: MHSO is Medicare health support organization. PBPM is per beneficiary per month.SOURCES: Centers for Medicare & Medicaid Services: Data from Medicare Inpatient, Outpatient, and Physician/Supplier Claims, 2004-2006; MHSO protocol 6.0, terms and conditions.
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f2-hcfr-30-01-047: Proportion of Net Total Savings1 Required and Achieved Through Pilot's First 6 Months, by MHSO1 Percentages on top of light bars include required 5 percent Medicare claims savings plus monthly fee as a percentage of the comparison group's per beneficiary per month.NOTES: MHSO is Medicare health support organization. PBPM is per beneficiary per month.SOURCES: Centers for Medicare & Medicaid Services: Data from Medicare Inpatient, Outpatient, and Physician/Supplier Claims, 2004-2006; MHSO protocol 6.0, terms and conditions.

Mentions: Figure 2, based on our method, shows each MHSO's early success in meeting the original pilot's financial requirement of 5 percent net savings over a 3-year period. (Actual refunds will be based on formula [1]). Figure 2's light bars show the percentage that the MHSO had to reduce the intervention's PBPM relative to its comparison group's PBPM to keep all its management fees. Monthly management fees during the first 6 months, as a proportion of comparison group PBPMs, ranged from a low of 5.3 percent (MHSO 1) to a high of 11.2 percent (MHSO 3). For example, MHSO 1's fee was 5.1 percent of its comparison group's average monthly health care payments. Adding the required 5 percent savings meant that MHSO 1 needed to save a total of 10.1 percent to keep all fees. PBPM reductions to keep all fees ranged from a low of 10.1 percent (MHSO 1) to a high of 15.8 percent (MHSO 3).


Evaluation of Medicare Health Support chronic disease pilot program.

Cromwell J, McCall N, Burton J - Health Care Financ Rev (2008)

Proportion of Net Total Savings1 Required and Achieved Through Pilot's First 6 Months, by MHSO1 Percentages on top of light bars include required 5 percent Medicare claims savings plus monthly fee as a percentage of the comparison group's per beneficiary per month.NOTES: MHSO is Medicare health support organization. PBPM is per beneficiary per month.SOURCES: Centers for Medicare & Medicaid Services: Data from Medicare Inpatient, Outpatient, and Physician/Supplier Claims, 2004-2006; MHSO protocol 6.0, terms and conditions.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195046&req=5

f2-hcfr-30-01-047: Proportion of Net Total Savings1 Required and Achieved Through Pilot's First 6 Months, by MHSO1 Percentages on top of light bars include required 5 percent Medicare claims savings plus monthly fee as a percentage of the comparison group's per beneficiary per month.NOTES: MHSO is Medicare health support organization. PBPM is per beneficiary per month.SOURCES: Centers for Medicare & Medicaid Services: Data from Medicare Inpatient, Outpatient, and Physician/Supplier Claims, 2004-2006; MHSO protocol 6.0, terms and conditions.
Mentions: Figure 2, based on our method, shows each MHSO's early success in meeting the original pilot's financial requirement of 5 percent net savings over a 3-year period. (Actual refunds will be based on formula [1]). Figure 2's light bars show the percentage that the MHSO had to reduce the intervention's PBPM relative to its comparison group's PBPM to keep all its management fees. Monthly management fees during the first 6 months, as a proportion of comparison group PBPMs, ranged from a low of 5.3 percent (MHSO 1) to a high of 11.2 percent (MHSO 3). For example, MHSO 1's fee was 5.1 percent of its comparison group's average monthly health care payments. Adding the required 5 percent savings meant that MHSO 1 needed to save a total of 10.1 percent to keep all fees. PBPM reductions to keep all fees ranged from a low of 10.1 percent (MHSO 1) to a high of 15.8 percent (MHSO 3).

Bottom Line: Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries.In this article, we present 6-month intervention results on beneficiary selection and participation rates, mortality rates, trends in hospitalizations, and success in achieving Medicare cost savings.Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization.

View Article: PubMed Central - PubMed

Affiliation: Research Triangle Institute International, Waltham, MA 02451, USA. jcromwell@rti.org

ABSTRACT
The Medicare Program is conducting a randomized trial of care management services among fee-for-service (FFS) beneficiaries called the Medicare Health Support (MHS) pilot program. Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries. In this article, we present 6-month intervention results on beneficiary selection and participation rates, mortality rates, trends in hospitalizations, and success in achieving Medicare cost savings. Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization.

Show MeSH
Related in: MedlinePlus