A 2003 study of three Medicaid DM programs (for all chronic conditions, not HIV-specific DM) indicated that the states’ varied program designs produced short-term net savings and improved outcomes in their patient populations (Gillespie & Rossiter, 2003). Because of the variability in the programs reviewed and the range of chronic co
Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Disease Management for Complex Medical Conditions
In January 2008, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) convened an expert panel to discuss outcomes measurement issues related to DM for populations with chronic conditions. The panel included researchers and clinicians, and the discussion noted that the inconsistency in methodologies used to evaluate DM prog
Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Disease Management: Findings from the Literature
Mixed results from studies of disease management programs in general indicate there is no conclusive evidence of the impact of the programs on cost-effectiveness and health outcomes. According to the Congressional Budget Office’s 2004 analysis of disease management studies for several chronic diseases, there is insufficient evidence to c
The prevalence of chronic disease in the U.S. is a significant public health issue. About 133 million people, almost half of all Americans, have at least one chronic health condition – for example, heart disease, asthma, or diabetes. The Centers for Disease Control and Prevention (CDC) estimates that chronic diseases account for 70% of a
Disease management (DM) refers to a system of coordinated health care interventions and communications to help patients self-manage their chronic diseases and prevent complications from these health conditions. DM has been touted by vendors as an effective tool to reduce health care costs. Some DM vendors have claimed that disease management progr
Disease management (DM) is a system of coordinated health care interventions and communications to help patients self-manage their chronic diseases and prevent complications from these health conditions.
This paper examines the limited evidence to date on the impact of disease management (DM) for low-income populations enrolled in public insurance programs, and explores issues concerning the effectiveness of DM targeted to people living with HIV/AIDS.
1. In general, "TANF" refers to other poverty-related populations in addition to TANF beneficiaries. However, Alabama makes a distinction between SOBRA women and SOBRA children; SOBRA children are mandatorily enrolled, while SOBRA adults are not eligible.
Case Study States' Enrollment Policies Alabama Florida Iowa Maine North Carolina Oklahoma Texas Virginia Patient 1 st
Emerging Practices in Medicaid Primary Care Case Management Programs. Appendix B: North Carolina Access II & III Core Elements of the Asthma Disease Management Program
Build Capacity for Routine Assessment of Asthma
Emerging Practices in Medicaid Primary Care Case Management Programs. Appendix A: Case Study States' Contacts
Charlene J. Benson Director, Medicaid Care Management Oklahoma Health Care Authority 4545 North Lincoln Suite 124 Oklahoma City, OK 73105 405-522-7366 email@example.com Scott F. Cannady Managed Care Unit Supervisor Department of Medical Assistance Services P.O. Box 537 Richmond, VA 23204 804-786-5445 SCannady@dmas.
As Medicaid managed care has evolved during the past decade, states have balanced the development of their PCCM programs with the growth and/or decline of risk-based managed care. Each state has taken a slightly different approach, depending in part on the state's particular managed care environment. Some states developed PCCM as a stepping stone
State advice on enrollment focused mostly on additional roles a contracted enrollment broker can play. Use the enrollment broker to recruit providers, in order to learn the area before starting member enrollment. Use the enrollment broker for member education. Do not try to enroll a great number of people into a mandatory program all at onc
States with active care coordination components to their PCCM programs reported that providers and beneficiaries found them very helpful. Other recommendations included Recognize that the referral process is key to managing services Make prior authorization and other state-required procedures as hassle-free as possible for providers. Employ