Fostering Rapid Advances in Health Care Learning from System Demonstrations (2003) / Chapter Skim
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2. Chronic Care: Reducing the Toll of Chronic Conditions on Individuals and Communities
2. Chronic Care: Reducing the Toll of Chronic Conditions on Individuals and Communities
Pages 27-40
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From page 27... ...
The public-private partnership should encompass all major stakeholders, including consumer groups, health care professionals, health care and social service organizations, the public health community, state government, and others.
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From page 28... ...
People with chronic conditions account for the majority Chronic illness affects all age groups and also leads to reduced worker productivity and lost of overall health care spending. time from school for children (National Academy on an Aging Society, 20004.
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For many with chronic conditions, navigating the complex health care system can be difficult, sometimes even distressingly so. The chronically ill typically require care from multiple clinicians (both primary care providers and specialists)
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Establishment of a strong public-private partnership Healthier community measurable decrease in the incidence of chronic conditions and the associated disease burden Improved capabilities at the state and community levels to address health care issues and to collaborate and invest in health system improvements DEMONSTRATION ATTRIBUTES It is anticipated that demonstration projects in this category would focus initially on a subset of Medicare beneficiaries, perhaps those with one or more conditions requiring intensive ongoing management. Over time, however, the projects would expand to include all of the chronically ill.
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In the area of personal health care, demonstration sites would be expected to establish comprehensive chronic care management programs including the following elements: . Evidence-based treatment programs for all of the leading chronic conditions that affect the population being served.
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From page 32... ...
also has disease management and coordinated care demonstration projects under way that focus on improved care delivery for specific beneficiaries through changes in payment, benefits, and organization of care (Centers for Medicare and Medicaid Services, 2002; U.S. Depatlt~ent of Health and Human Services, 2001~.
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In some communities, disease management programs sponsored by medical groups, health systems, or health plans may serve as initial building blocks. However, the chronic care management programs in these demonstration projects are intended to differ Tom typical disease management programs in several important ways.
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There might also be some opportunity to transfer the knowledge and technology developed in a specific location to new demonstration projects starting up in other locales. One example of an initiative already under way is the diabetes telemedicine collaborative in New York State (IDEATel, 2002~.
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From page 35... ...
Within the overall constraint of budget neutrality, demonstration sites should be given the flexibility to use Medicare funds in ways that would yield the greatest benefits in terms of improved patient and population health. One financing approach would be for CMS to provide the coordinating structure, with a capitation payment to cover all the care needs of the participating patients (i.e., preventive, acute, and chronic care)
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From page 36... ...
POSSIBLE DEMONSTRATION EXPANSIONS Although the primary focus of these demonstrations is on Medicare beneficiaries, all demonstration projects should have a tentative plan from the beginning for expansion beyond Medicare to other public and private payers. The structures and programs developed by the demonstration projects are intended to benefit all people in the community both those with chronic conditions and those without who might delay or avoid the onset of such conditions through primary prevention.
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From page 37... ...
2002. Medicare Program; Solicitation for Proposals for He Demonstration Project for Disease Management for Severely Chronically Ill Medicare Beneficiaries With Congestive Heart Failure, Diabetes, and Coronary Heart Disease.
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2001. Medicare Fact Sheet: Providing Coordinated Care to Improve Quality of Care for Chronically Ill Medicare Beneficiaries.
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1997. Collaborative Management of Chronic Illness.
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