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Enhancing Medicare Chronic Care Improvement Programs: A Voluntary Approach for Beneficiaries

This update discusses the Voluntary Chronic Care Improvement Program (CCIP) under Medicare, aimed at improving care for chronically ill beneficiaries without changing their existing plans or introducing insurance risk to organizations. Initiated by section 721 of P.L. 107-183, it focuses on regional pilot programs to be tested through randomized controlled trials, involving 20,000 chronically ill beneficiaries per program. Key features include voluntary participation, physician involvement, and the development of CMS infrastructure to support health interventions and enhance care quality.

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Enhancing Medicare Chronic Care Improvement Programs: A Voluntary Approach for Beneficiaries

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  1. Update on Medicare Chronic Care Improvement Programs Sandra M. Foote Division of Chronic Care Improvement Programs Center for Medicare Management January 28, 2005

  2. “Voluntary Chronic Care Improvement under Traditional Fee-For-Service”* *Section 721 of P.L. 107-183, Medicare Prescription Drug, Improvement and Modernization Act of 2003

  3. Agreement, $ Fees at risk: QI, $,satisfaction Targeted Beneficiaries CCI Organization DHHS Beneficiaries’ Physicians Data exchange

  4. Key Features of CCIP • Voluntary participation • No change of plans, providers, benefits, or claims administration • No shift of insurance risk to CCI organizations • Supportive, not restrictive • Not a substitute for current care

  5. PHASE I - DEVELOPMENTAL Large scale, regional pilot programs to be tested through 3-year randomized controlled trials 9 regional program awards made 12/08/04 20,000 chronically ill beneficiaries per program; 10,000 per control group Staggered start dates in 2005

  6. Preliminary Findings • Market response • Physician involvement • CMS infrastructure development

  7. Market response • Innovative proposals • Broad spectrum of interventions • Diverse programs • Regions with high disease prevalence and low quality rankings

  8. Medicare Chronic Care Improvement Programs 7 6 2 9 8 3 1.Humana 2. Aetna 3. Lifemasters 4. McKesson 5. CIGNA 6. VNSNY/UHCS 7. Health Dialog 8. XLHealth 9. American Healthways 4 5 1 Diabetes Prevalence Medicare non-HMO

  9. Physician Involvement • Many new national and regional alliances developing with CCIP awardees Examples: - American College of Physicians - American College of Cardiology - American Academy of Family Physicians

  10. CMS Investment • Strong leadership support • Staff and contractors on board • Development work underway -Performance monitoring system -Information management system -CMS outreach -Planning for regional programs -Independent evaluation

  11. More Information: http://www.cms.hhs.gov/medicarereform/ccip/

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