Results of the Medicare Health Support Disease-Management Pilot Program
McCall, N., & Cromwell, J. (2011). Results of the Medicare Health Support Disease-Management Pilot Program. New England Journal of Medicine, 365(18), 1704-1712. DOI: 10.1056/NEJMsa1011785
Management of care for chronic illness, with its focus on high-risk, high-cost patients, is touted as a valuable initiative to improve health outcomes while potentially saving Medicare billions of dollars. Medicare fee-for-service beneficiaries must navigate a health care system structured and financed to manage their acute, rather than long-term, health problems.1,2 When Medicare beneficiaries seek medical care, their health problems are typically treated in costly and uncoordinated settings rather than managed in a holistic fashion.3,4 As a result, nearly all growth in Medicare spending between 1987 and 2002 can be accounted for by beneficiaries with five or more medical conditions.5
The concept of managing care for chronic illness has been evolving for years with the emergence of competing models. As described by Bodenheimer,6 the practice-based model emerged from the initiative Improving Chronic Illness Care. This model focuses on improving the care of chronic illness by embedding disease-management programs in physician practices and modifying clinical practice to inform patients about the nature of the care they need and to involve them in processes of their own care.7-13 In contrast, the commercially based disease-management model relies much less on physicians to provide support for the management of chronic care. Historically, commercial disease-management programs were marketed to commercial health plans and employers as tools to achieve medical cost savings and to reduce absenteeism from work, with improvement in the care of chronic illness being a secondary goal. The commercial disease-management model uses teams of health coaches, usually in remote call centers, to enhance beneficiaries' knowledge of and skills in provision of self-care and to coordinate care across providers.