Performance Improvement 2009. How Can We Improve Health Outcomes and Reduce Medicare Expenditures for Certain Medicare Beneficiaries With Heart Problems?


The evaluation examined the impact of providing disease management services and a prescription drug benefit for Medicare fee-for-service beneficiaries with congestive heart failure, coronary artery disease or diabetes. Three disease management organizations participated in the demonstration. The evaluation used a randomized design where eligible beneficiaries were recruited, then randomized into a treatment or control group.

Results of the evaluation showed that the effect of the prescription drug benefit on beneficiary access to prescription drugs was small. There were some positive impacts of disease management on a few of many care process measures: more chronic heart failure patients served by two of the programs had left ventricular assessments, and more diabetics in one program had more claims for self-monitoring supplies, podiatry visits, therapeutic shoes and urine tests for protein. There were no treatment control group differences in beneficiary satisfaction with general health care or with any of the aspects of care they were asked about, nor were there differences on the measures of physical functioning or perceived mental and physical health quality of life. The analyses indicated that the demonstration had no impacts on hospitalizations, readmissions, emergency room use or on Medicare Part A and B expenditures. The demonstration ended early when it became clear that the programs were unable to generate savings to the Medicare program to offset their fees.

Report Title: Evaluation of Medicare Disease Management Programs; Report may be obtained from Federal Contact

Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Lorraine Johnson, 410-786-9457
Performer: Mathematica Policy Research, Inc.
PIC ID: 8963

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"PerformanceImprovement2009.pdf" (pdf, 1.26Mb)

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