Report Says Medicare Coordinated Care Demo Has Not Yet Shown Significant Cost Savings, Behavior Modifications
April 30th, 2007
Few programs participating in the first two years of Medicare’s Coordinated Care Demonstration (MCCD) experienced significant cost savings or changes in patient utilization, according to a report released April 11 by the Mathematica Policy Research, Inc. (Mathematica).
The Centers for Medicare and Medicaid Services (CMS) initiated the MCCD in January 2002 to test “whether case management and disease management programs can lower costs and improve patient outcomes and well-being in the Medicare fee-for-service population,” Mathematica explained in a press release.
CMS selected fifteen demonstration programs to participate in the MCCD, which was slated to operate for four years but was extended until 2008 for eleven of the programs.
Mathematica’s report, The Evaluation of the Medicare Coordinated Care Demonstration: Findings for the First Two Years, found that, although “patients and physicians were generally very satisfied with their [particular] program,” most programs did not have “statistically detectable effects on patients’ behavior or use of Medicare services.”
Among the report’s other findings were:
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Few effects on beneficiaries’ overall satisfaction with care;
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An increase in the percentage of beneficiaries reporting that they had received some health education, but no clear effects on patients’ adherence to diet, medication, exercise, or other self-care regimens;
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Favorable quality-of-care effects for only two of the fifteen participating programs (each on indicators measuring quality of preventive care, number of preventable hospitalizations, and patients’ well-being);
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Only one of the fifteen participating programs reduced the number of hospitalizations over the first twenty-five months of the MCCD, and no programs reduced expenditures for Medicare Part A and B services over this time period.
“It is too soon to expect impact on some of these outcomes, and sample sizes for some programs are small,” commented Randall Brown, lead author of the report. “Final results covering the full…evaluation period will provide more definitive evidence of program effects.”
The report noted that “changing ingrained behaviors of physicians and patients and improving communications among non-integrated fee-for-service providers are all difficult tasks to achieve,” and moreover, “such improvements in the processes of care may not yield statistically discernable [effects on] patients’ well-being or reductions in Medicare costs over the first 2 years of program operations.”
Read Mathematica’s press release.
Read Mathematica’s report.
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