Medicare Pilot Program Set To Begin
CMS last week announced it has enrolled 100,000 Medicare beneficiaries in a pilot program to test a coordinated care system for individuals with multiple chronic conditions, the Wall Street Journal reports.
CMS says that individuals with five or more chronic conditions make up 23% of Medicare beneficiaries but account for 68% of costs. Such patients are often "under the care of multiple specialists who don't communicate, share medical records or coordinate treatment plans," increasing the risk that they will "be hospitalized when different doctors recommend conflicting treatments or take care of one condition while letting another go unattended," the Journal reports.
The pilot program will "test whether a new layer of care can actually reduce costs in the long run," the Journal reports.
CMS will pay eight companies monthly fees to coordinate the beneficiaries' care. Most of the companies will use nurses working from call centers, and some will make house calls to check on patients.
The companies will have to refund some or all of the fees if they do not cut 5% of costs and show that beneficiaries are healthier and more satisfied with their quality of care.
James Pope, chief medical officer at Healthways, said, "We aren't trying to insert ourselves into the doctor's role of creating a care plan, but we are educating and empowering patients by asking them if they know that two medications they are taking are the same thing."
However, "many doctors say using third-party disease-management companies to monitor patients from afar isn't as effective as having a single doctor oversee care," the Journal reports (Landro, Wall Street Journal, 2/8).