Of interest to those with SSDI & Medicare

[Guest guest]

Wednesday, 6-Oct-2004 News-Medical.Net

Medicare today announced a demonstration project for Medicare

beneficiaries with high medical expenses

The Centers for Medicare & Medicare Services (CMS) today announced a

demonstration to find ways to improve the health and quality of life of

Medicare beneficiaries with high medical expenses while reducing costs

for the program and the beneficiaries.

" A relatively small number of people on Medicare, many of whom are very

ill, account for most of our spending. A modern health care system needs

to find opportunities to improve their lives, " said CMS Administrator

Mark B. McClellan, M.D. Ph.D. " We're going to find the most promising,

innovative approaches. And we're going to provide financial rewards for

lower costs and better quality. "

The demonstration will study various care management models for

high-cost beneficiaries in the traditional Medicare fee-for-service

program. These might include intensive care management, increased

provider availability, structured chronic care programs, restructured

physician practices, and expanded flexibility in care settings.

Fifteen percent of Medicare fee-for-service beneficiaries account for

approximately 75 percent of the total Medicare expenditures each year.

Many of these beneficiaries have multiple conditions and are at high

risk of continuing to require intensive medical services.

For some very ill patients, this restructuring of care to integrate

provider services and to deliver those services in locations such as the

beneficiary's home could significantly approve their quality of life

while also reducing costs for the beneficiary and Medicare.

While CMS has a number of planned and ongoing care coordination and

disease management demonstrations and programs, the Care Management for

High-Cost Beneficiaries demonstration will be the first effort to focus

specifically on high-cost fee-for-service Medicare beneficiaries.

The demonstration will be published in the Federal Register on Oct. 6.

The notice invites physician groups, hospitals, and integrated delivery

systems to submit proposals for participating in this demonstration.

Other types of organizations may apply, but they must be part of a

consortium that includes at least one of the above entities and play a

major role in carrying out the demonstration.

Applicants must specify the types of conditions and the demographic and

other characteristics of beneficiaries that their care management models

are designed to serve.

Participating organizations may propose a monthly fee to cover their

administrative and/or care management costs, and they may propose a plan

to share a portion of the savings from the demonstration. However,

organizations will be required to assume financial risk if they do not

meet established performance standards for clinical quality of care,

beneficiary and provider satisfaction, and savings to Medicare.

Beneficiaries eligible for participation in the demonstration will be

identified by CMS as meeting its high-cost guidelines as well as any

additional targeting criteria for the individual programs.

The demonstration will not restrict a beneficiary's access to regular

Medicare services or providers, and participating beneficiaries will

assume no financial liability for the administrative and care management

fees.

http://aging.senate.gov