CMS urges states to adopt disease management programs

Sunday, February 29, 2004

March 1, 2004

WASHINGTON - In a letter to state Medicaid officials last month, CMS announced it would match state costs of running disease management programs aimed at improving health outcomes while lowering the medical costs associated with these diseases.

“Disease management is an exciting opportunity to significantly improve the care delivered to Medicaid beneficiaries with chronic conditions,” said Dennis Smith, acting director of CMS. “It uses the best of managed care techniques of coordinating care that may not have been available in a fee-for-service delivery system.”

Studies have shown that persons with chronic illnesses like diabetes, asthma, congestive heart failure, hypertension and other long-term diseases use a disproportionate share of medical services. These beneficiaries frequently are treated by multiple providers whose care is not coordinated, potentially leading to duplicative and unnecessary services and driving up medical expenses. Disease management is a set of interventions designed to improve the health of these individuals by working more directly with them and their physicians on their treatment plans regarding diet, adherence to medicine schedules and other self-management techniques.