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Medicare Coordinated Care Demonstration

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

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Medicare Coordinated Care Demonstration

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

  2. 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

  3. 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

  4. MCCD Milestones Best Practices Report March 2000 15 Sites Selected January 2001 1st Report to Congress Spring 2004 Waiver Development Site Training Phased Implementation Solicitation Issued July 2000 OMB Waiver Package Approved March 2002 Site Negotiation Systems Changes

  5. 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

  6. 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

  7. Enrollment Progressing Across Sites

  8. 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

  9. CMS DM Demonstrations • Medicare Coordinated Care Demonstration • Cindy Mason, Project Director -- CMason1@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 – SMazumdar@cms.hhs.gov

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

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