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4/22/2004

CMS Announces Chronic Care Projects

Donna Young

The Centers for Medicare & Medicaid Services (CMS) is soliciting proposals from organizations, including disease management groups, health insurers, integrated delivery systems, and physician group practices, to provide self-care guidance and support to chronically ill Medicare beneficiaries.

The program will serve about 150,000 to 300,000 beneficiaries who are enrolled in traditional fee-for-service Medicare and who have multiple chronic conditions, including congestive heart failure (CHF), complex diabetes, and chronic obstructive pulmonary disease (COPD), according to CMS.

The agency plans to have up to 10 project sites to provide services to 15,000 to 30,000 beneficiaries in specific regions around the country over a three-year period. Each project will have an intervention group and a control group.

The program is not a demonstration project, CMS stressed on its Web site. The agency is not testing whether chronic care improvement "is a good idea, but how to incorporate these services into traditional fee-for-service Medicare at scale."

Groups providing chronic care services will be required to collaborate with beneficiaries' primary care providers. There is no additional cost to beneficiaries, the agency stated.

Gary Stein, director of federal regulatory affairs for the American Society of Health-System Pharmacists (ASHP), said that the CMS chronic care program is an "excellent opportunity for ASHP members to provide appropriate care to Medicare beneficiaries."

"Pharmacists are experts in managing medication therapy for patients with chronic conditions," he said.

The Voluntary Chronic Care Improvement Program, which was authorized under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, will "increase adherence to evidence-based care, reduce unnecessary hospital stays and emergency room visits, and help participants avoid costly and debilitating complications," according to CMS.

Medicare beneficiaries with five or more chronic conditions represent 20 percent of beneficiary population but 66 percent of program spending, according to CMS.

About 14 percent of Medicare beneficiaries have CHF but account for 43 percent of Medicare spending, and about 18 percent of Medicare beneficiaries have diabetes, accounting for 32 percent of Medicare spending.

The government is calling for applicants in geographic areas that have a high prevalence of CHF, diabetes, or COPD among beneficiaries, and poor Medicare quality rankings compared to national averages.

Groups providing the care services will be paid a monthly fee per participating beneficiary. However, payments are linked to the quality of care provided, beneficiary and provider satisfaction, and savings to Medicare in the intervention groups compared to control groups, the agency stated.

The deadline for applications is August 6, 2004.