Abstract
Introduction: Provisions in the Balanced Budget Act of 1997 directed the US Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration) to begin focusing attention on the standardized measurement of health outcomes of Medicare beneficiaries as well as testing the effectiveness of various disease management interventions at improving these outcomes.
The CMS, in collaboration with the US National Committee for Quality Assurance, developed the Medicare Health Outcomes Survey (HOS) as the first health outcomes measure from the patient’s perspective in Medicare managed care. This new source of data, using the Medical Outcomes Study Short Form 36-Item Health survey (SF-36®) as its core measure, provides valuable standardized health outcomes information about Medicare managed care enrollees in general and the chronically ill in particular.
Study design: From May through July 1998, a longitudinal, self-administered survey which utilized the SF-36® (a health status measure which assesses both physical and mental functioning) was administered to 1000 randomly sampled Medicare beneficiaries who were continuously enrolled for a 6-month period in a Medicare managed care health plan. This cohort was re-surveyed from April though June of 2000. We analyzed data from the cohort I baseline and re-measurement analytic sample of 51 700 individuals.
Results: Using the change in SF-36® physical component summary scores and mental component summary scores over a 2-year period, we demonstrated that the presence of chronic disease has a negative impact on both the physical and mental health functioning of Medicare managed care enrollees over time. With few exceptions, the negative effect of chronic disease on physical and mental health is found to be independent of gender, race, and socioeconomic status as measured by level of educational attainment. Differences in mean health status scores across levels of chronic conditions suggest that preventing the onset of disease is best for maintaining optimal health.
Conclusions: Disease management interventions which are properly designed and implemented have been shown to measurably improve patient outcomes by providing high quality, cost-effective care. Recognizing the need for standardized outcome measures and scientifically validated disease management interventions, the CMS has taken a leadership role by developing and implementing the Medicare HOS and disease management demonstration projects.
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References
Marmor T. The politics of Medicare. 2nd ed. Hawthorne (NY): Aldine de Gruyter, 2000.
Wagner EH. The promise and performance of HMOs in improving outcomes in older adults. J Am Geriatr Soc 1996; 44: 1251–7.
National Center for Health Statistics. Health, United States, 2001. Hyattsville (MD): Public Health Service, 2002.
Kane RL. The chronic care paradox. J Aging Soc Policy 2000; 11(2–3): 107–14.
Centers for Medicare and Medicaid Services. Protecting Medicare beneficiaries when their Medicare+Choice organization withdraws [online]. Available from URL: http://www.cms.hhs.gov/media/press/release.asp?.Counter=402 [Accessed 2002 Apr 16].
Lewis A. Irresistible force called DM facing some immovable objects. Manag Care 1999; 8(11): 32, 34.
Marietti C. Seize the disease! If you don’t take charge of your high-risk, high-cost patients, your competitors will. Healthc Inform 1999; 16(3): 43–4, 46, 48–54.
Bringewatt RJ. Making a business case for high-quality chronic illness care. Health Aff (Millwood) 2001; 20(6): 59–60.
Bierman AS, Lawrence WF, Haffer SC, et al. Functional health outcomes as a measure of health care quality for Medicare beneficiaries. Health Serv Res 2001 Dec; 36(6) Part II: 90–109.
Tarlov AR, Ware JE, Greenfield S, et al. The Medical Outcomes Study: an application of methods for monitoring the results of medical care. JAMA 1989; 262: 925–30.
Ware JE, Snow KK, Kosinski M, et al. SF-36® Physical and mental health summary scales: a user’s manual. Boston (MA): The Health Institute, 1993.
Health Care Financing Review. Medicare and Medicaid statistical supplement, 1998. Baltimore (MD): US Department of Health and Human Services, Healthcare Financing Administration, Office of Strategic Planning, 1998.
HCFA Statistics. Baltimore (MD): US Department of Health and Human Services, Health Care Financing Administration Office of Strategic Planning. HCFA Pub. No. 03410. 1998 Dec.
Fein O. The influence of social class on health status: American and British research on health inequalities. J Gen Intern Med 1995; 10: 577–86.
Singer MA, Hopman WM, MacKenzie TA. Physical functioning and mental health in patients with chronic mental conditions. Qual Life Res 1999; 8(8): 687–91.
Ware JE, Kosinski M. SF-36® Physical and mental health summary scales: a manual for users of version 1. 2nd ed. Lincoln (RI): QualityMetric, 2001.
Schore J, Brown B, Cheh V. Case management for high-cost Medicare beneficiaries. Health Care Financ Rev 1999; 20(4): 87–101.
Bodenheimer T. Disease management: promises and pitfalls. N Engl J Med 1999; 340(15): 1202–5.
Boult C, Kane RL, Brown R. Managed care of chronically ill older people: the US experience. BMJ 2000; 321(7267): 1011–4.
Clemmitt M. Perspectives: disease management for Medicare: how many paradigms can we shift today? Med Health 2001; 55(9): Suppl 1–4.
Bruce D, Dickmeyer J. Don’t overlook disease management programs for lowincidence, high-cost diseases to improve your bottom line. J Health Care Finance 2001; 28(2): 45–9.
Hagland M. Getting it together: integrating disease management. Healthplan 2000; 41(1): 42–6.
Centers for Medicare and Medicaid Services. HCFA announces sites for new coordinated care demonstration to improve care to chronically ill [online]. Available from URL: http://www.cms.hhs.gov/media/press/release.asp?.Counter=263 [Accessed 2002 Apr 16].
Mathematica Policy Research. Best practices in coordinated care [online]. Available from URL: http://www.mathematica-mpr.com/3rdlevel/bestprac.htm [Accessed 2002 Apr 16].
Balanced Budget Act of 1997 Medicare and Medicaid Provisions. Section 4016. Subchapter D: other projects: medicare coordinated care demonstration project. Available from URL: http://www.hcfa.gov/regs/budget97.htm [Accessed 2002 Apr 16].
Acknowledgements
The views expressed here are those of the authors and do not necessarily represent the position of the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services, or the Health Services Advisory Group, Inc.
The authors wish to thank Kimberly Neuman and William Clark, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services for historical disease management and coordinated care information within Medicare, Cynthia Mason and Tamara Jackson-Douglas, Center for Beneficiary Choices, for providing information on the demonstration projects, and Arlene S. Bierman, M.D., M.S., Senior Research Physician, Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality, for suggestions and editorial comments.
The analyses on which this publication is based were performed under contract number 500-99-AZ02 titled “Utilization and Quality Control Peer Review Organization for the State of Arizona - Medicare Health Outcomes Survey Applied Research Center” sponsored by the Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, Maryland, US.
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Haffer, S.C., Bowen, S.E., Shannon, E.D. et al. Assessing Beneficiary Health Outcomes and Disease Management Initiatives in Medicare. Dis-Manage-Health-Outcomes 11, 111–124 (2003). https://doi.org/10.2165/00115677-200311020-00005
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DOI: https://doi.org/10.2165/00115677-200311020-00005