1 / 12

The Epidemic of Chronic Disease: Medicare Health Support as a Response

The Epidemic of Chronic Disease: Medicare Health Support as a Response. Growing Prevalence of Chronic Conditions. 141 M. 125 M. Source: RAND. 70 Million Americans with Multiple Chronic Conditions in 2010. 70 Million. 60 Million. Source: RAND.

amir-hewitt
Download Presentation

The Epidemic of Chronic Disease: Medicare Health Support as a Response

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. The Epidemic of Chronic Disease:Medicare Health Supportas a Response

  2. Growing Prevalence of Chronic Conditions 141 M 125 M Source: RAND

  3. 70 Million Americans with Multiple Chronic Conditions in 2010 70 Million 60 Million Source: RAND

  4. Beneficiaries With 5 or More Chronic Conditions Account for Two-Thirds of Medicare Spending Source: Medicare 5% Sample, 2001

  5. Context Fee-For-Service Medicare • 35 million people • $281 billion/year (projected 2005)

  6. What is Medicare Health Support (MHS)? • Enacted in Medicare Modernization Act • Three year randomized controlled studies of chronic care management in fee-for-service Medicare • Conditions: Heart failure and complex diabetes (95% have co-morbidities) • Eight pilot programs, with one in Maryland/DC • Size per program: 20,000 beneficiaries in intervention group, 10,000 beneficiaries in control group • Awardees have 100% risk for fees to improve costs a net 5% over control group • Program may be expanded to entire nation after two years

  7. Program Locations

  8. Key Program Features • Voluntary • No charge to participants • No change in Medicare benefits, choice of providers or claims payment • Supportive, not restrictive • Not a substitute for current care

  9. Expected Results • Improved health and quality of life • Lower average Medicare costs • Reduced complications, emergencies and hospital admissions • Increased adherence to evidence-based care guidelines • Better coordination of care through use of new health information and communication technologies

  10. American Healthways • Founded 1981 • Operate the most sophisticated care management centers in the country • Every care enhancement program designed to support the patient-physician relationship

  11. American Healthways MHS Program • Disease Management for 76% • Telephonic, RNs • Outbound scheduled calls • Geriatric assessments • Improve adherence to physician care plan • Patient empowerment • Intensive Case Management for 20% • Telephonic and face-to-face, RNs and Geriatric NPs • High risk for hospitalization • Coordination with physician(s) • Coordinate community resources • Long Term Care Management for 4% • Face-to-face in nursing homes, RNs and Geriatric NPs • End-of-life planning, pain & palliative care, hospice referral • Early detection of potentially reversible causes of hosp admissions

  12. Medicare Health Support Goals • Improved quality of care • Increased beneficiary and provider satisfaction • Medicare cost savings Win - Win - Win for beneficiaries, providers and Medicare

More Related