House Subcommittee Debates Private Disease Management Programs in Medicaid
Members of the House Energy and Commerce Health Subcommittee on Wednesday discussed the impact on costs and quality of care in the Medicaid program of implementing disease management plans and debated whether private companies should be involved in such programs, CongressDaily reports (Rovner, CongressDaily, 10/15). Nationwide, 24 states have implemented disease management programs in which Medicaid beneficiaries' chronic diseases are monitored, and officials from those states told the committee that beneficiaries who participate in the programs are hospitalized less often, reducing costs for emergency room visits and hospital stays. For example, a Florida disease management program for patients with congestive heart failure decreased spending by more than 16% over two years, Christobel Selecky, chief executive of LifeMasters Supported SelfCare, which administered the program, testified. About 25% of Medicaid beneficiaries have chronic illnesses, but treatments for chronic illnesses account for about 75% of Medicaid spending, according to subcommittee Chair Michael Biliarikis (R-Fla.) (Sherman, AP/Las Vegas Sun, 10/15).
Although Democrats on the panel approved of more closely monitoring and counseling beneficiaries with chronic illnesses, they questioned whether private companies should be contracted to provide such services. They said that states might save more money if they operated such programs themselves instead of delegating responsibility to private companies, which take a portion of the savings as profits. Rep. Sherrod Brown (D-Ohio) said that state-run efforts might provide a higher quality of care. "Effective disease management, like effective health care, hinges on continuity. HMOs undoubtedly do some things well, but providing continuity of care is not one of them," Brown said. Indiana Medicaid official Melanie Bella said that her state had considered contracting with private companies for a disease management program but decided against it because a state-operated program could provide "permanent, long-term structural change" (CongressDaily, 10/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.