Performance Improvement 2008. Did Various Chronic Disease Treatment Programs Perform Cost Effectively, Improve Quality, and Satisfy Patients and Providers?


This biennial evaluation of the Medicare Coordinated Care Demonstration sought to determine whether 15 demonstration programs of care coordination for chronically ill fee-for-service beneficiaries improved health outcomes and reduced Medicare costs for targeted groups of beneficiaries. The evaluation addressed several questions: was the demonstration cost effective; was quality of health care services improved; and were beneficiaries and health care providers satisfied with the care rendered?

Over the course of the first 25 months, the programs individually and collectively did not demonstrate changes in either savings or costs. However, because of the relatively small sample sizes and substantial chance of variation in costs from year-to-year, it is possible that the some programs be cost neutral. Although patients in the demonstration programs reported receiving education about their condition and treatment regimen, no statistically significant differences between treatment and control groups were found. Physicians and patients were highly satisfied with the demonstration programs. Overall, 67 percent of physicians believed that demonstration program interventions improved quality of patient care, and 80 percent reported that they would recommend the program to colleagues. Patients across all programs reported appreciation of the increased attention and coordination of services by the registered nurse care managers.

Since improvement in chronic disease care takes time to translate into better health outcomes and lower costs, 25 months is likely too short a span to see the maximum impact of such programs on costs and outcomes, and longer follow-up is needed. In 2005, it was decided to continue 11 of the 15 programs until 2008 in order to attain sufficient follow up data, on a greater number of enrollees, to make an informed assessment of the outcomes of the program.

Report Title: Second Report to Congress on the Evaluation of the Medicare Coordinated Care Demonstration,
Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Magee, Carol, 410-786-6611
Performer: Mathematica Policy Research; Washington, DC
PIC ID: 8687

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