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Medicare Testing Program to Help Diabetes, Heart
Failure Patients Have Better Lives
Aug. 2, 2005 – A new initiative to help Medicare
beneficiaries with diabetes and congestive heart failure reduce their
health risks and protect their quality of life was announced today by
the Centers for Medicare & Medicaid Services (CMS). Named “Medicare
Health Support,” the program will support eight pilot programs this year
in different areas of the country. Services will provide free, voluntary
support programs, for approximately 160,000 fee-for-service Medicare
beneficiaries for three years.
“Because early intervention is tremendously
important in treating chronic illnesses, we are providing beneficiaries
additional tools to help them manage their health more effectively and
avoid preventable complications,” said Health and Human Services’
Secretary Mike Leavitt.
Chronic diseases are often the underlying cause of
illness, disability and death for many American seniors and account for
the majority of Medicare expenditures. For example, about 14 percent of
Medicare beneficiaries have congestive heart failure among their chronic
conditions, and these beneficiaries account for 43 percent of Medicare
spending. About 18 percent of Medicare beneficiaries have diabetes, yet
account for 32 percent of Medicare spending.
“We are excited to be working with 35 national
partners, including the AARP and the American Diabetes Association,
among others, to inform the pre-selected Medicare beneficiaries and
their health care providers about the new Medicare Health Support pilot
programs,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “We
share common goals of reducing health risks, improving quality of care,
and increasing the worth of Medicare.”
Participation in a Medicare Health Support program
will be completely voluntary and will not affect beneficiaries’ Medicare
coverage, their access to medical services, or their ability to choose
their own doctors and other health care providers. The programs are not
a new form of insurance plan or HMO and will be available at no charge
to beneficiaries who are invited to participate.
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Medicare Health Support programs will offer
self-care guidance and support to chronically ill beneficiaries to help
them manage their health, adhere to their physicians’ plans of care and
ensure that they know when to seek the medical care necessary to help
reduce their health risks. The specific types of quality improvement and
cost reduction strategies to help beneficiaries with chronic illnesses
include the following:
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Access to nurse coaches to help people cope
with their health concerns.
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Tracking and reminding participants and their
doctors about preventive care needs.
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Use of health information technology to give
physicians timely access to their patients’ information.
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Home monitoring equipment to track participant
health status, as needed.
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Prescription drug counseling.
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Home visits and intensive case management, when
needed.
The programs will include collaboration with
participants’ providers to enhance communication of relevant clinical
information. They are intended to help increase adherence to
evidence-based care, reduce unnecessary hospital stays and emergency
room visits, and help participants avoid costly and debilitating
complications.
“This program is just one component of the greatest
change in Medicare since it was founded 40 years ago,” said Dr.
McClellan. “The Medicare Modernization Act of 2003 brought us new
flexibility to design programs to help our chronically ill beneficiaries
better manage their overall health. We are investing more in health to
reduce preventable complications and avoidable health care costs.”
Program launches for the eight regions are as
follows:
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American Healthways, Inc., Washington D.C. and
Maryland – August 1, 2005
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Lifemasters Supported SelfCare, Inc., Oklahoma
– August 1, 2005
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Health Dialog Services Corporation, Western
Pennsylvania – August 15, 2005
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McKesson Health Solutions, LLC, Mississippi –
August, 2005
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CIGNA Healthcare, Northwest Georgia – Fall 2005
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Aetna Life Insurance Company, LLC, Chicago ,
Illinois – Fall 2005
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Humana, Inc., Central Florida – Fall 2005
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A ninth awardee, Visiting Nurse Service of New
York in partnership with United HealthCare Services, Inc., Evercare,
is in discussions with CMS regarding the Brooklyn/Queens, NY, pilot.
Each program will test a variety of interventions
to bring about improvements in clinical quality, beneficiary and
provider satisfaction and reduced costs. More information about the
Medicare Health Support initiative is available at
http://www.cms.hhs.gov/medicarereform/ccip.
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