CMS Deputy Administrator Advocates Increased Use of Disease Management for Medicare Beneficiaries

Disease management programs could improve the quality of care provided to seniors enrolled in fee-for-service Medicare and help strengthen the long-term financial solvency of the program, CMS Chief Operating Officer and Deputy Administrator Ruben King-Shaw told members of a House subcommittee on April 16. Disease management programs provide best practice guidelines that doctors can use to prevent complications and improve outcomes for patients with chronic diseases, such as diabetes, hypertension, asthma and congestive heart failure, King-Shaw said at a hearing of the House Ways and Means Subcommittee on Health. He also said that the programs may help to reduce unnecessary hospitalizations and services and decrease costs. CMS recently launched a number of demonstration projects, including a new program announced in February that combines disease management and prescription drug treatment, to "identify innovative ways to include coordinated disease management services in an inherently uncoordinated fee-for-service system," King-Shaw said, adding that the projects could affect future Medicare reforms. According to King-Shaw, one of the projects, a three-year End Stage Renal Disease Managed Care Demonstration that began in September 1996, found that seniors with ESRD who participated in disease management programs "exhibited comparable or better outcomes" than those enrolled in fee-for-service Medicare. He said that disease management programs should serve as a "natural progression" for Medicare as the baby boom generation reaches retirement age and more seniors with chronic diseases enroll in the program.

Lawmaker Reaction
Subcommittee Chair Nancy Johnson (R-Conn.) agreed that disease management programs could "dramatically improve" the quality of fee-for-service Medicare and reduce the cost of the program. However, Rep. Pete Stark (D-Calif.), ranking member of the subcommittee, raised questions about whether disease management programs would actually reduce Medicare costs. King-Shaw said that "in the aggregate, the costs to Medicare will be the same or lower" as a result of disease management programs, although he admitted that the cost of care may increase for some individual cases "in which appropriate medical services were previously underutilized." Rep. Karen Thurman (D-Fla.) also raised concerns about problems that have previously prevented the implementation of disease management programs in fee-for-service Medicare. King-Shaw said that fee-for-service Medicare does not have an organized care delivery system that could serve as a "ready-made platform" for the programs. He said that CMS hopes to use results of the demonstration projects to help address the problem. He added, however, that disease management programs offer "no substitute for the comprehensive coverage" that many beneficiaries receive from Medicare+Choice plans and recommended that lawmakers increase reimbursement rates to prevent the withdrawal of additional health plans from the program. "The most important step that Congress could take right now to allow seniors who depend on disease management to keep these valuable services, and to provide rapid access to such services to many more seniors who need them, is to fix the problems with the payment system for private plans" he said (Josh Kotzman, Kaiser Daily Health Policy Report, 4/17). A HealthCast of this hearing is available online.