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Published on: January 8, 2020

Medicare disease management in policy context

Ariel Linden1, Julia Adler-Milstein

  • 1Oregon Health & Science University, USA. alinden@lindenconsulting.org

Health Care Financing Review
|June 24, 2008
PubMed

Insights

Commercial disease management (DM) programs struggle with short-term cost savings. Focusing on reducing hospitalizations could improve Medicare health support (MHS) outcomes.

Area of Science:

  • Health Economics
  • Chronic Care Management
  • Healthcare Policy

Background:

  • Medicare health support (MHS) demonstration projects are evaluating disease management (DM) cost-effectiveness.
  • Current DM programs often prioritize process measures, potentially delaying medical cost savings.

Purpose of the Study:

  • To analyze why commercial DM models fail to achieve short-term medical cost savings.
  • To identify necessary changes in DM strategies for improved near-term financial returns within MHS.

Main Methods:

  • Analysis of interim results from MHS demonstration projects.
  • Examination of the characteristics of current commercial DM models.
  • Assessment of the impact of process measures versus outcome-based interventions.

Main Results:

  • Interim MHS data indicate commercial DM is not delivering short-term medical cost savings.
  • The focus on process compliance in DM may hinder immediate financial benefits.
  • Programs targeting near-term hospitalization reduction show greater potential for savings.

Conclusions:

  • Commercial DM, as currently structured, is unlikely to yield short-term cost savings in MHS.
  • A shift towards outcome-focused strategies, particularly hospitalization reduction, is recommended for MHS.
  • Policymakers may need to reconsider commercial DM in favor of alternative chronic care management approaches.

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