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Congestive heart failure disease management in Medicare-managed care.
Am Heart J. 2007 Dec; 154(6):1153-9.AH

Abstract

BACKGROUND

In 2001, the Center for Medicare and Medicaid Services began 2 initiatives that encouraged Medicare-managed care plans to introduce congestive heart failure (CHF) disease management programs. Our study was designed to describe the use, structure, and content of these programs.

METHODS

In 2003 to 2004, we invited the representatives of Medicare-managed care plans with > or = 750 enrollees to participate in a survey by mail or telephone.

RESULTS

Representatives of 120 plans, 84 (70%) responded. Of the plans, 92% had CHF programs, 45% of which were instituted in 2001 or later, and 42% of which were handled externally by commercial vendors. Vendor use was more common in large programs (> 30,000 Medicare enrollees) than in small programs (< 15,000 Medicare enrollees) (57% vs 24%, P = .05), in national than local programs (50% vs 21%, P = .03), and in for-profit than not-for-profit programs (45% vs 21%, P = .03). Although 87% of CHF programs focused on improving patient self-management, a smaller fraction engaged practicing physicians (eg, 23% provided feedback to physicians concerning whether care was consistent with CHF guidelines).

CONCLUSIONS

In Medicare-managed care plans, there is widespread use of CHF disease management. However, the programs used primarily focus on patient self-management and not on engaging physicians on medication management and compliance with guidelines. Our findings raise the concern that these programs will not be able to achieve the quality improvement and cost savings previously demonstrated in clinical trials of CHF disease management.

Authors+Show Affiliations

RAND Health, the Division of General Internal Medicine, University of Pittsburgh Medical School, Pittsburgh, PA, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18035089

Citation

Mehrotra, Ateev, et al. "Congestive Heart Failure Disease Management in Medicare-managed Care." American Heart Journal, vol. 154, no. 6, 2007, pp. 1153-9.
Mehrotra A, McNeil BJ, Landon BE. Congestive heart failure disease management in Medicare-managed care. Am Heart J. 2007;154(6):1153-9.
Mehrotra, A., McNeil, B. J., & Landon, B. E. (2007). Congestive heart failure disease management in Medicare-managed care. American Heart Journal, 154(6), 1153-9.
Mehrotra A, McNeil BJ, Landon BE. Congestive Heart Failure Disease Management in Medicare-managed Care. Am Heart J. 2007;154(6):1153-9. PubMed PMID: 18035089.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Congestive heart failure disease management in Medicare-managed care. AU - Mehrotra,Ateev, AU - McNeil,Barbara J, AU - Landon,Bruce E, Y1 - 2007/09/14/ PY - 2007/05/11/received PY - 2007/07/24/accepted PY - 2007/11/24/pubmed PY - 2007/12/6/medline PY - 2007/11/24/entrez SP - 1153 EP - 9 JF - American heart journal JO - Am Heart J VL - 154 IS - 6 N2 - BACKGROUND: In 2001, the Center for Medicare and Medicaid Services began 2 initiatives that encouraged Medicare-managed care plans to introduce congestive heart failure (CHF) disease management programs. Our study was designed to describe the use, structure, and content of these programs. METHODS: In 2003 to 2004, we invited the representatives of Medicare-managed care plans with > or = 750 enrollees to participate in a survey by mail or telephone. RESULTS: Representatives of 120 plans, 84 (70%) responded. Of the plans, 92% had CHF programs, 45% of which were instituted in 2001 or later, and 42% of which were handled externally by commercial vendors. Vendor use was more common in large programs (> 30,000 Medicare enrollees) than in small programs (< 15,000 Medicare enrollees) (57% vs 24%, P = .05), in national than local programs (50% vs 21%, P = .03), and in for-profit than not-for-profit programs (45% vs 21%, P = .03). Although 87% of CHF programs focused on improving patient self-management, a smaller fraction engaged practicing physicians (eg, 23% provided feedback to physicians concerning whether care was consistent with CHF guidelines). CONCLUSIONS: In Medicare-managed care plans, there is widespread use of CHF disease management. However, the programs used primarily focus on patient self-management and not on engaging physicians on medication management and compliance with guidelines. Our findings raise the concern that these programs will not be able to achieve the quality improvement and cost savings previously demonstrated in clinical trials of CHF disease management. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18035089/Congestive_heart_failure_disease_management_in_Medicare_managed_care_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(07)00607-2 DB - PRIME DP - Unbound Medicine ER -