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Chronic Disease Management Medicare Project – Success or Failure?

by Derrick

The results of a Medicare cost saving project that tried to successfully manage older adults with chronic diseases was, if you’re reading this MSNBC article, a failure. I’ll beg to differ with the article’s assessment in a moment, but here is what happened:

  • Centers for Medicare and Medicaid Services (CMS) selected 15 test-site programs in 2002 that tried keep sick, aging patients out of hospitals and cut costs
  • The sites developed their own programs, enrolling a total of 18,309 fee-for-service Medicare patients
  • About half received standard care, and the rest received managed care with a nurse available to advocate, encourage, and educate the patient
  • Many patients had more than one chronic disease
  • Only two sites cut the number of times patients were hospitalized
  • None saved Medicare money

So the goal of the project was not met, but does this mean all was lost? I think not, for what it illustrated is the difficulty in trying to change patient behavior. The project’s failure was not the delivery of effective case management, but the patients’ inability or unwillingness to adopt a healthy lifestyle.

The article states:

“The only way you can really do it is by changing patients’ behavior and by changing physicians’ behavior, and both things are really hard to do,” said study author Randall Brown, a researcher at Mathematica Policy Research Inc., in Princeton, N.J., which was hired to evaluate the programs.

Often, these patients need to stop smoking, or lose weight, exercise more, eat healthier foods — a challenge even for generally healthy people. Those changes are especially tough for sick, older patients who often are set in their ways.

The story cited one success story within the various projects, however. A 74-year old retired man from Pennsylvania followed the case manager’s advice, ate healthy meals and exercised. He lost 60 pounds, his blood pressure and cholesterol improved, and his pre-diabetes evaporated.

The results of this study then begs the question: How does one get another to change his/her lifestyle for him/herself AND for the system supporting everyone?

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