Evaluation of the extended Medicare Care Management for High Cost Beneficiaries (CMHCB) demonstration

Abstract

The purpose of this report is to present the findings from RTI International’s evaluation of the Health Buddy® Program at Montefiore, a Care Management for High Cost Beneficiaries (CMHCB) demonstration program jointly implemented by Robert Bosch Healthcare Systems, Inc. (RBHC) and Montefiore Medical Center’s (MMC’s) Care Management Organization (hereafter referred to as MMC’s CMO). The Medicare CMHCB demonstration was designed to address current failings of the health care system for chronically ill Medicare fee-for-service (FFS) beneficiaries. The principal objective of the demonstration was to test new models of care for Medicare beneficiaries, who are high cost and/or who have complex chronic conditions, with the goals of reducing future costs, improving quality of care, and improving beneficiary and provider satisfaction. On July 6, 2005, the Centers for Medicare & Medicaid Services (CMS) announced the selection of six care management organizations to operate programs in the CMHCB demonstration:

1. The Health Buddy® Consortium (HBC), composed of Robert Bosch Healthcare Systems, Inc. (RBHC, formerly known as the Health Hero Network), the American Medical Group Association (AMGA), Bend Memorial Clinic, and Wenatchee Valley Medical Center
2. Care Level Management (CLM)
3. Massachusetts General Hospital (MGH) and Massachusetts General Physicians Organization (MGPO) and its Care Management Program (CMP)
4. Montefiore Medical Center (MMC) and its Care Guidance Program (CGP)
5. VillageHealth (formerly known as RMS) and its Key to Better Health program (KTBH)
6. Texas Tech University Health Sciences Center (TTUHSC) and its Texas Senior Trails (TST) program

On January 13, 2009, CMS announced that it was granting 3-year extensions, subject to annual renewal, for three participants in the CMHCB demonstration that had demonstrated some success managing the care of their selected beneficiaries: Key to Better Health, a division of Village Health; Massachusetts General Hospital Care Management Program; and Robert Bosch Healthcare Systems, Inc.’s (RBHC) Health Buddy® Program.