update on medicare chronic care improvement programs sandra m. foote division of chronic care...
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![Page 1: Update on Medicare Chronic Care Improvement Programs Sandra M. Foote Division of Chronic Care Improvement Programs Center for Medicare Management January](https://reader036.vdocuments.us/reader036/viewer/2022082518/56649eb75503460f94bc187a/html5/thumbnails/1.jpg)
Update on Medicare Chronic Care Improvement Programs
Sandra M. Foote
Division of Chronic Care Improvement Programs
Center for Medicare Management
January 28, 2005
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“Voluntary Chronic Care Improvement under Traditional
Fee-For-Service”*
*Section 721 of P.L. 107-183, Medicare Prescription Drug, Improvement and Modernization Act of 2003
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Beneficiaries’Physicians
Targeted Beneficiaries CCI
Organization
DHHS
Fees at risk: QI, $, satisfaction
Fees at risk: QI, $, satisfaction
Agreement, $Data exchange
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Key Features of CCIP• Voluntary participation
• No change of plans, providers, benefits, or claims administration
• No shift of insurance risk to CCI organizations
• Supportive, not restrictive
• Not a substitute for current care
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PHASE I - DEVELOPMENTALLarge scale, regional pilot programs to be tested
through 3-year randomized controlled trials
9 regional program awards made 12/08/04
20,000 chronically ill beneficiaries perprogram; 10,000 per control group
Staggered start dates in 2005
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Preliminary Findings
• Market response• Physician involvement• CMS infrastructure development
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Market response• Innovative proposals • Broad spectrum of interventions • Diverse programs• Regions with high disease prevalence and low quality rankings
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Fraction of BeneficiariesAny Dx on 2001 M.D. claim (incl. lab, xray)
0 .202 to 0.223 (10)0 .185 to 0.202 (9)0 .159 to 0.185 (11)0 .134 to 0.159 (9)0 .023 to 0.134 (12)
Estimated Prevalence of Diabetes, All non-HMO Medicare, 2001
1.Humana2. Aetna3. Lifemasters4. McKesson5. CIGNA6. VNSNY/UHCS7. Health Dialog8. XLHealth 9. American Healthways
1
2
34 5
67
89
Medicare Chronic Care Improvement Programs
Diabetes Prevalence Medicare non-HMO
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Physician Involvement
• Many new national and regional alliances developing with CCIP awardees
Examples: - American College of Physicians- American College of Cardiology- American Academy of Family Physicians
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CMS Investment
• Strong leadership support• Staff and contractors on board• Development work underway
-Performance monitoring system -Information management system -CMS outreach -Planning for regional programs
-Independent evaluation
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More Information:http://www.cms.hhs.gov/medicarereform/ccip/