CMS initiatives give ‘stamp of approval’ to DSM

Monday, May 31, 2004

WASHINGTON - CMS in April began accepting applications for the Voluntary Chronic Care Improvement Program, a new initiative aimed at bettering the quality of life for people living with chronic illnesses.

The initial program will reach 150,000 to 300,000 beneficiaries in traditional fee-for-service Medicare and will focus on implementing programs for patients with congestive heart failure, complex diabetes and COPD.

Contracts will be awarded in each of the test areas, and the flexible model of the program has opened it to the whole gamut of health care providers.

“We think DME and other providers have a lot to offer here,” said a CMS official during an April 23 Open Door Forum.

Studies have shown that disease management programs save money through better coordination of patient treatment and limiting unnecessary medical expenses by using treatment plans that focus on diet, adherence to medicine schedules and other self-management techniques.

Chronic illnesses are a leading cause of illness, disability and death among Medicare beneficiaries and account for a disproportionate share of health care expenditures, according to the Department of Health and Human Services. About 14% of Medicare beneficiaries have congestive heart failure and account for 43% of Medicare spending. Diabetes accounts for 32% of Medicare spending.

“Too often, seniors with serious chronic illnesses move from doctor to doctor for their specific health problems without any single doctor getting a full picture of their needs,” said HHS Secretary Tommy Thompson in a press release. “This new program will give them the support they need to better manage their conditions and stay healthy.”

No specific plan of care has been outlined for the Chronic Care Improvement Program. The principal goal of the test sites is to develop new strategies for improving quality of care - and doing so cost effectively.

“[CMS’s plan] gives a boost of legitimacy to disease management,” said Roberta Domos, owner of Domos HME Consulting Group. “It’s a stamp of approval by Medicare that disease management programs are worthwhile.”

Requirements for application in the program are included in a Federal Register notice issued on April 23.

In another move that brings disease management strategies to the forefront, CMS announced this spring that it would match state costs of running disease management programs.