Report to Congress on the Evaluation of Medicare Disease Management Programs

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Report to Congress on the Evaluation of Medicare Disease Management Programs

This congressionally mandated report summarizes the final evaluation findings for the Demonstration Project for Disease Management for Severely Chronically Ill Medicare Beneficiaries (referred to hereafter as the Medicare Disease Management Demonstration), authorized in Section 121 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 (P.L. 106-554). Congress authorized the demonstration to evaluate whether disease management programs—in conjunction with a comprehensive prescription drug benefit—for Medicare beneficiaries in the fee-for-service program with advanced-stage congestive heart failure (CHF), diabetes, or coronary artery disease (CAD), could improve health outcomes and reduce Medicare expenditures. In late 2002, the Centers for Medicare & and Medicaid Services (CMS) selected three organizations, CorSolutions, (later purchased by Matria Healthcare, Inc.), HeartPartners (UnitedHealth, Inc. later purchased PacifiCare, one of HeartPartners’ main members), and XLHealth, to operate demonstration programs in Louisiana, Arizona, California, and Texas.

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