Medicare chronic care improvement

CMS has released information on the Federal government's chronic care improvement initiative. This is the first large-scale chronic care improvement initiative under the Medicare FFS program and was part of last year's Medicare pharmaceutical legislation. Bidder's conference is scheduled May 13. We don't know how much interest CMS has in the Medicare/Medicaid dually eligibles, but they ought to have a lot.

Here are the highlights from their release:

In Phase I, the pilot phase, there will be approximately 10 regional CCI programs, collectively serving approximately 150,000 - 300,000 chronically ill beneficiaries, in regions where at least 10% of Medicare beneficiaries reside. The Phase I programs will operate for 3 years and be evaluated through randomized controlled trials.

The program will offer self-care guidance and support to chronically ill beneficiaries to help them manage their health, adhere to their physicians’ plans of care, and assure that they seek (or obtain) medical care that they need to reduce their health risks.

The programs will include collaboration with participants’ providers to enhance communication of relevant clinical information. The programs are intended help to increase adherence to evidence-based care, reduce unnecessary hospital stays and emergency room visits, and help participants avoid costly and debilitating co-morbidities and complications.

Initially, the programs will be focused on beneficiaries who have congestive heart failure or complex diabetes because these beneficiaries have heavy self-care burdens and high risks of experiencing poor clinical and financial outcomes.

The new programs are NOT single-disease focused. They will be designed to help participants manage all their health problems.

Participation will be entirely voluntary. Eligible beneficiaries do not have to change plans or providers or pay extra to participate. They will be able to stop participating at any time. They will not restrict access to care.

Selected organizations will be required to refund some or all of their fees to the federal government if they do not meet agreed-upon standards for quality improvement, savings to Medicare, and increased satisfaction levels in their assigned beneficiary populations.

This is a flexible business model. Health insurers, disease management organizations, physician group practices, integrated delivery systems, and consortia of these entities or other legal entities the Secretary determines appropriate are all eligible to apply to become CCI organizations.

I like the open-endedness of this and especially like that it is not about single disease management, which is a very limited concept.