Medicare Health Support: Managing Care for Chronic Illness

Delivering needed health services in a timely, cost-effective way to seniors with chronic health conditions is at the top of the nation's policy agenda. As mandated by the Medicare Modernization Act, the Centers for Medicare & Medicaid Services (CMS) has launched phase one of the Medicare Health Support (MHS) program. CMS has contracted with eight disease management organizations to provide services to beneficiaries with heart failure and/or diabetes in eight states. Phase one runs for three years.

With funding from CMS, Mathematica is developing disease management performance measures and a performance measurement system. During phase one, we are running the system and computing the financial liability, if any, of the participating disease management organizations. The performance measures include clinical, utilization, and satisfaction measures, as well as program operations measures for monitoring. Mathematica developed the protocol sites use to submit clinical, satisfaction, and program operations data, and is combining these date with claims-based measures to produce quarterly performance reports for each site.

Mathematica's team includes Health Services Advisory Group, the quality improvement organization covering Arizona, which is conducting medical record reviews of samples of participants in all eight states. We are also supporting CMS in its ongoing implementation efforts to make MHS a success.

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