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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

Medicare Coordinated Care Demonstration

John Pilotte, Research Analyst

Office of Research, Development, and Information

Third National Disease Management Summit

May 13, 2003

mccd overview
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
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
mccd milestones
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

site characteristics
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
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
observations
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
CMS DM Demonstrations
  • Medicare Coordinated Care Demonstration
  • BIPA Disease Management Demonstration
  • Capitated Disease Management Demonstration
  • ESRD Disease Management Demonstration
cms demonstrations web page
CMS Demonstrations Web Page

http://www.cms.hhs.gov/healthplans/research

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