Feds Offer Matching Funds to Bring Disease Management to
State Medicaid Programs
Nancy Johnson Provides National Leadership on Chronic Care
Washington, DC (March 2004) — Congresswoman
Nancy Johnson today hailed the federal government's initiative urging states to adopt disease
management programs to improve the quality of life for those with chronic illnesses and
hold down health care costs.
Late last week, the Centers for Medicare and Medicaid Services (CMS) wrote state Medicaid
officials to announce that it would match state costs of running disease management programs.
"I am extremely pleased that Medicaid is making this giant leap forward to improve
quality of care for Medicaid patients," said Johnson, Chairman of the House Ways and
Means Health Subcommittee and a recognized leader in bringing disease management into Medicare. "By
helping people with chronic illnesses stay healthier and out of the hospital or nursing
home, we vastly improve their quality of life and save precious public dollars. At a time
of high numbers of uninsured and tight state budgets, this initiative to help finance Medicaid
disease management programs will make a big difference for Medicaid beneficiaries and taxpayers."
"As a leader in prevention and chronic disease management, Cardium Health is excited
about the CMS's decision to financially back chronic disease management services," said
Charleen Ernst, President and CEO of Cardium Health of Farmington. "Helping to spearhead
healthcare initiatives in the State of Connecticut and nationwide, Congresswoman Nancy
Johnson has advocated for the value of chronic disease management for almost a decade and
Cardium is pleased that Nancy has been so successful at bringing disease management to
the forefront of public policy."
Persons with chronic illnesses such as diabetes and congestive heart failure use a disproportionate
share of medical services. Chronic illness treatment accounts for 75 percent of total national
health care spending. In the Medicare program, 10 percent of beneficiaries with chronic
illnesses account for 70 percent of medical spending. They often have multiple providers
prescribing multiple prescriptions and treatment regimens.
Disease management programs focus on preventing chronic conditions from getting worse,
or letting diabetes, for example, result in amputation, blindness, or dependence on dialysis.
These programs coordinate care between patients and physicians; and they assist patients
in taking more control over their lifestyle, monitoring their health, and reporting small
but important health changes to their physician. By monitoring chronic illnesses and coordinating
care among health care providers, patients are able to remain healthier and avoid painful
care in high cost settings such as emergency rooms and hospitals.
"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, of the new initiative.
In its letter to states, CMS outlines several avenues whereupon state Medicaid programs
will receive matching funds from the federal government if they adopt disease management
programs. States may contract with a disease management organization that would manage
the overall care of the beneficiary, but does not restrict access to other Medicaid services.
A state may pay the disease management organization a capped amount per beneficiary with
the organization being responsible for any expenses over the set amount.
States may also establish a primary care case management program (PCCM). In these programs,
the state works with PCCM providers to enhance the care it delivers to enrollees with chronic
conditions. Additional support from the state could be given for especially complex cases.
Individual providers (physician, pharmacists, or dietitians) can also contract with states
to provide management services. Providers often undergo specialized training before undertaking
this program.
This announcement comes on the heels of CMS implementing disease management programs into
fee-for-service Medicare, programs Johnson championed as a key architect of the Medicare
prescription drug bill.
"Now Medicare and Medicaid will be able to focus on keeping beneficiaries healthier
in addition to treating them when they are ill," Johnson concluded. "With these
new tools, Medicare and Medicaid enrollees will have access to 21st century quality care."
Contact
Jennifer Kaduk
marketing@cardiumhealth.com
860.677.8900
About Cardium Health: Cardium Health is a national health
improvement and disease management company. As one of the leading providers of disease
management programs to large, self-insured employers, the company’s core focus is
on reducing healthcare costs by providing medical support and educational interventions
to those individuals with chronic conditions. The Company’s people-centered disease
management programs are based on proven clinical and economic best-practice protocols.
They include such conditions as heart disease, diabetes, asthma, COPD, back pain and smoking,
and easily integrate into employers' back-to-work and wellness initiatives. For more information
about Cardium Health and its programs, visit www.cardiumhealth.com,
email cardium@cardiumhealth.com,
or call 860.677.8900.
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