Navigation Links
Medicare Faces Challenges Caring for Chronically Ill

Initiatives to lower costs, improve service seldom work, study finds

TUESDAY, Feb. 10 (HealthDay News) -- Only a fraction of Medicare pilot programs aimed at cutting costs and improving care for people with chronic illness actually did the job, a new study shows.

That doesn't necessarily mean that ideas like these should be abandoned altogether, however.

Based on the findings, "we should not expect these care coordination efforts to pay for themselves or to save money," said Paul Precht, director for policy and communications at the Medicare Rights Center. "But that doesn't mean they're not worth doing, because when they work right, they can deliver better health for people."

And what makes them work right?

"If you target the programs well on people who have the right level of severity of illness and types of illnesses, and you have certain features, then you can have an impact on hospitalization rates. That's the key," said study senior author Randall Brown, vice president and director of health research at Mathematica Policy Research Inc. in Princeton, N.J. Mathematica designed this pilot project.

"The more that providers and particularly the physicians are directly involved and the more the physicians are part of an integrated network that includes the other specialties, the better [a particular program] works," added Precht.

The findings were published in the Feb. 11 issue of the Journal of the American Medical Association.

Most experts agree that exploding costs and the prospect of an empty purse threaten Medicare's future. According to an accompanying editorial, Medicare expenditures will top $400 billion this year, a hefty 13 percent of the total federal budget.

One study found that in 2002, about half of beneficiaries who had been treated for five or more conditions accounted for 75 percent of total spending.

Most of the costs associated with chronic illness come from hospital stays which, in turn, are often due to inadequate care between admissions (lack of counseling on improving lifestyle factors, lack of adherence to medication regimens, etc.).

One proposed solution is to better coordinate care between different physicians and other health care providers.

This complex analysis looked at 15 care-coordination programs involving more than 18,000 fee-for-service Medicare patients with chronic problems such as congestive heart failure, coronary artery disease and diabetes. Each program included between 178 and 2,657 patients. Care was assessed after individuals had been in the program at least seven months. The outcomes were then compared to those of a control group consisting of "usual care."

Only two of the 15 programs showed any significant difference in hospitalization rates, and one of those actually involved an increase of 0.118 admissions per person per year.

In one program, Mercy Medical Center in rural northwestern Iowa achieved 0.168 fewer admissions per person per year, 17 percent less than the control group.

Not one of the programs resulted in net savings, although three programs --- including Mercy and Health Quality Partners (HQP) in Pennsylvania -- did achieve some savings. HQP also had "close to significant effects on hospitalizations," Brown said.

The two success stories, Mercy and HQP, had certain features in common, namely more contact between nurse-coordinators and patients and more contact between coordinators and physicians.

"Both these programs had good relationships with local hospitals and with patients' physicians," Brown said. "The care coordinator knew the physicians, because they were either located in the same facility or the physicians set aside space for the care coordinator to interact with patients when the patients came in for a visit. They bumped into each other a lot."

Overall, however, the picture was not a positive one.

"It is discouraging. I think there's good reason to be skeptical of what these stand-alone disease-management companies can do," Precht said. "The record is mixed, but it's pretty clear, they don't save money."

More information

There's more on specific programs at the Medicare Web site.

SOURCES: Randall Brown, Ph.D., vice president and director, health research, Mathematica Policy Research Inc., Princeton, N.J.; Paul Precht, director, policy and communications, Medicare Rights Center; Feb. 11, 2009, Journal of the American Medical Association

Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. CDS Completes Large-Scale Transition of Medicare Data Processing
2. Medicare Drug Plan Doughnut Hole Could Impact Seniors Health
3. Seniors in Medicares doughnut hole decrease use of meds
4. First Coast Service Options Announces Start up of New Medicare Contract
5. Nurses to Congress: Expanding Medicare Could Reverse Job Losses, and Repair Our Broken Healthcare System and Safety Net
6. CMS Selects Thomson Reuters to Help Implement Medicare Medical Home Demonstration Project for Medicare Recipients
7. Burgess to Co-Chair and Serve as Lead Sponsor for WRGs 2009 The Business Of Medicare Advantage Forum
8. PWeR(TM) Platform Available to Increase Provider Reimbursements From Medicare
9. A Newly Approved CMS Medicare Package Expands Reimbursement Coverage for Telehealth Originating Sites Beginning January 1, 2009
10. Actuaries Laud New Presidents Medicare and Social Security Message, Call for Bipartisan Solution
11. American Association for Homecare Criticizes Release of Controversial Medicare Bidding Rule in Final Hours of Bush Administration
Post Your Comments:
Related Image:
Medicare Faces Challenges Caring for Chronically Ill
(Date:6/26/2016)... (PRWEB) , ... June 26, 2016 , ... PawPaws ... a new product that was developed to enhance the health of felines. The formula ... , The two main herbs in the PawPaws Cat Kidney Support Supplement ...
(Date:6/25/2016)... ... June 25, 2016 , ... The temporary closing of Bruton Memorial Library on June 21 due ... up a new, often overlooked aspect of head lice: the parasite’s ability to live away ... a common occurrence, but a necessary one in the event that lice have simply gotten ...
(Date:6/25/2016)... ... ... Friday, June 10, Van Mitchell, Secretary of the Maryland Department of Health and Mental ... exemplary accomplishments in worksite health promotion. , The Wellness at Work Awards took place ... BWI Marriott in Linthicum Heights. iHire was one of 42 businesses to receive an ...
(Date:6/24/2016)... ... 24, 2016 , ... Marcy was in a crisis. Her son James, eight, was out of ... verbally and physically. , “When something upset him, he couldn’t control his emotions,” remembers Marcy. ... throw rocks at my other children and say he was going to kill them. ...
(Date:6/24/2016)... ... 2016 , ... Topical BioMedics, Inc, makers of Topricin and MyPainAway Pain Relief Products, join The ... raise to $12 an hour by 2020 and then adjusting it yearly to increase at ... the minimum wage, assure the wage floor does not erode again, and make future increases ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... -- According to a new market research ... Safety Pen Needles), Needle Length (4mm, 5mm, 6mm, 8mm, ... Purchase (Retail, Non-Retail) - Trends & Global Forecasts to ... for the forecast period of 2016 to 2021. This ... 2021 from USD 1.65 Billion in 2016, growing at ...
(Date:6/23/2016)... Research and Markets has announced the addition of the ... report to their offering. ... failure, it replaces the function of kidneys by removing the ... the treatment helps to keep the patient body,s electrolytes such ... Increasing number of ESRD patients & substantial healthcare expenditure on ...
(Date:6/23/2016)... DUBLIN , June 23, 2016 ... "Global MEMS Devices Medical Market Analysis 2016 - Forecast to ... The report contains up to date financial ... reliable analysis. Assessment of major trends with potential impact on ... dive analysis of market segmentation which comprises of sub markets, ...
Breaking Medicine Technology: