Medicare Health Support Pilot Program Fails to Cut Costs or Improve Quality

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Commercial disease management models did not reduce hospital admissions or emergency room visits or result in cost savings in a study of nearly 250,000 Medicare patients conducted by researchers at RTI International for the Centers for Medicare and Medicaid Services.

Under the Medicare Modernization Act of 2003, CMS was required to test the commercial disease management model in the Medicare Health Support Pilot Program. This model relies on teams of health coaches, usually in remote call centers, to educate patients; boost patients' ability to care for themselves; and coordinate care among providers.


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Researchers studied nearly 250,000 patients who were randomly assigned to a commercial program for disease management or usual care. Results showed that commercial disease-management companies had no success in reducing hospital admissions or emergency room visits among fee-for-service Medicare beneficiaries and had only limited success in improving the processes of care.

The results also showed that commercial disease-management programs achieved only modest improvements in quality-of-care measures and had no demonstrable reduction in the use of acute care or the costs of care.

The researchers suggest that the model may not work for Medicare partly because of the difficulty in managing older, chronically ill patients, who are more likely than younger patients to have new acute conditions such as stroke, pneumonia or a hip fracture. The authors also found that the health coaches were not integrated into the patient's primary healthcare team, which can impede the coaches' ability to interact with the patient's primary care providers and facilitate changes in medical care plans made by the primary care provider.

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