Creative Approaches to Managing Disease

Telemedicine

More than 18 percent of Medicare beneficiaries older than 65 have diabetes, a condition associated with high morbidity. Interactive technology holds promise for helping people with diabetes, and other chronic illnesses, better manage their diseases and prevent costly complications.

Mathematica is evaluating a demonstration that uses “telemedicine” to monitor patients with diabetes who live in areas where they have trouble accessing care. From December 2000 through October 2002, the demonstration enrolled 1,665 New York Medicare beneficiaries from medically underserved areas, who were randomly assigned to treatment and control groups. The treatment group received telemedicine services; the control group received the usual care, without case management or telemedicine services. A second phase of this demonstration will enroll an additional 300 beneficiaries and will examine alternative approaches to delivering telemedicine services to this population.

The evaluation estimates the demonstration's impacts on beneficiaries' clinical outcomes, access to care, use of services, quality of life, and costs. It also analyzes utilization of the telemedicine services/resources, and assesses the demonstration's implementation. Findings will help the Centers for Medicare & Medicaid Services and Congress decide about future expansions of this type of intervention.

Disease Management

We are evaluating a demonstration program designed to improve the health care and outcomes of Medicare beneficiaries with severe congestive heart failure, coronary heart disease, or diabetes. The program is expected to reduce total Medicare costs for enrollees by providing coverage for prescription drugs, and by using disease management techniques to improve care and adherence to recommended medication, diet, and exercise regimens. The impact analysis will rely on Medicare claims data and a patient survey administered six months after enrollment to estimate separate and combined effects of prescription drug coverage and disease management techniques. The implementation analysis will examine the design and operational experience of programs. The study, funded by the Centers for Medicare & Medicaid Services, will include case studies of each program, an analysis report, a report to Congress, and a final evaluation report.

Wise Use of Preventive Health Services

Mathematica is developing evidence-based best practices for delivering nutrition and physical activity lifestyle interventions to financially disadvantaged women who participate in the Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program for the Centers for Disease Control and Prevention using the RE-AIM framework. To identify best practices, we conducted a literature review and five in-depth case studies at selected WISEWOMAN projects. The case studies included interviews with federal, state, and local staff; observations of lifestyle intervention sessions; and focus groups with current program participants. We are also developing resources, in the form of a manuscript and a tool kit, for dissemination to the appropriate audiences.

Mathematica formed a consultant group to advise the CDC and HRSA about WISEWOMAN and Statewide Partnerships in Women's Health, facilitated consultant group meetings, and developed an Electronic Resource Guide to facilitate communication between participants in the Statewide Partnerships for Women's Health. The consultant group addressed issues related to the ethics of tracking and follow-up with participants after screening, as well as evaluation concerns for WISEWOMAN.

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