TABLE 3-1 Findings from Select Medicare Demonstration Projects

Project (Start Year)

Purpose

Outcomes

Care Management for High Cost Beneficiaries (2005)

To study various care-management models for high-cost beneficiaries in the traditional Medicare fee-for-service program who have one or more chronic diseases (e.g., Texas Senior Trails; Health Buddy).

Ongoing. Will review 3-year pilot programs implemented by six Care Management Organizations (CMOs).

Community Nursing Organization Demonstration (2003)

Tested the use of nurse case managers to coordinate care and provide enrollees with a more flexible array of services, such as prevention and health promotion, under a capitated arrangement.

Enrollment did not affect health status or utilization of services covered under the traditional Medicare benefit package. Total expenditures for treatment groups were significantly greater than the control group.

Medicare Disease Management Demonstration (2003)

To evaluate the effect of disease-management services, coupled with a prescription drug benefit, for those with advanced-stage congestive heart failure, diabetes, or coronary disease.

The three demonstration sites encountered difficulties identifying and enrolling beneficiaries, and, given the magnitude of the risk they faced, the project was discontinued prior to the intended conclusion date.

Medicare Coordinated Care Demonstration (2001)

To test whether providing coordinated-care services to Medicare beneficiaries with complex chronic conditions can yield better patient outcomes without increasing program costs.

Interim evaluation found increases in beneficiary education but no effect on satisfaction, patient adherence, self care, or Medicare expenditures. There was a small but statistically significant reduction in the proportion of patients hospitalized during the year after enrollment.

Informatics for Diabetes Education and Telemedicine (IDEAtel) (2000)

To test the use of telemedicine networks to improve primary and preventive care for Medicare beneficiaries with diabetes who live in underserved inner-city and rural areas of New York.

Interim evaluation shows the project had favorable effects on diabetes control and care, use of recommended medications, and communication with health care providers about diet and care. The demonstration did not generate savings to the Medicare program and was costly to implement ($8,200 to $8,900 per enrollee per year).

Medicare Case Management (Early Coordinated Care) Demonstrations (1995)

To provide case-management services to beneficiaries with catastrophic illnesses and high medical costs.

Despite high levels of satisfaction among the beneficiaries who participated, there was no improvement in self care or health. Medicare spending was not reduced.

SOURCE: CMS, 2008a.



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