Chronic Care Model to Be Tested in Pilot Project

Financial incentives and technology support for physicians are two “carrots” Medicare is testing to help improve chronic disease care for beneficiaries.

Primary care groups are collaborating with health care contractors to test a model of care that supports the physician's role in managing chronic disease.

The voluntary Medicare Chronic Care Improvement Program, a demonstration project created under the Medicare Modernization Act of 2003, is expected to reach about 180,000 fee-for-service Medicare beneficiaries with chronic health conditions such as complex diabetes or heart failure.

Not all details have been worked out, but the American College of Physicians and other primary care groups plan to work with two health care contractors “to find out how these models will work in the context of the project,” said Robert Doherty, ACP's senior vice president for governmental affairs and public policy.

Developed by Edward H. Wagner, M.D., an internist and epidemiologist, the chronic care model features an evidence-based team approach and physician incentives. It also emphasizes information technology and real-time decision support.

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions got the contract for Mississippi. Those companies were the only two that proposed the physician-guided, patient-centered model of care in their bids to Medicare, Mr. Doherty said.

The ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson. The company “is doing all the ground work on the project, but all three physician groups will serve as subcontractors,” Mary Frank, M.D., AAFP president, told this newspaper.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the firm “wanted to test a model that supports and enables the physician's care plan and strengthens the relationship between chronically ill patients and their doctors.” Slated to begin in June or September, the pilot test includes a chronic care management fee to recognize the time and effort involved in the initiative, he said. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans.”

The ACP plans to submit a white paper to Congress, outlining a more ambitious request to test the model in its entirety in a separate demonstration project, Mr. Doherty said. “We believe there should be a larger demonstration, to take the full components developed by Dr. Wagner” and test their effectiveness in smaller physician practices.

The ACP will be submitting the model along with a series of proposals that address broader payment issues for physicians. “Our sense is, we may need additional authority to test the model—that Congress should enact legislation to allow CMS to launch another demonstration project to allow full evaluation of the model,” Mr. Doherty said.

Primary Care Has Room to Improve

Primary care doctors have not been proactive in ensuring regular interactions with their chronically ill patients, according to Dr. Wagner.

Care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records,” he said at a healthy policy meeting last November.

Management of these patients usually relies on symptoms and lab results, not long-term disease control and prevention. “Most patients are receiving rushed admonitions to shape up, not counseling and supportive interventions that work,” said Dr. Wagner, who directs Improving Chronic Illness Care (ICIC), a national program of the Robert Wood Johnson Foundation.

The ACP white paper cited studies from the Institute of Medicine, Rand Corp., and CMS, showing that care for the chronically ill was fragmented and costly because of a lack of coordination under fee-for-service. This makes the large-scale testing of a patient-centered chronic care model “crucial to the health system's viability.”

Key elements of Dr. Wagner's model include:

▸ Mobilizing community resources to meet patient needs—for example, encouraging patients to participate in effective community programs.

▸ Reorganizing the health care system to encourage open and systematic handling of errors and quality problems to improve care and providing incentives to improve quality of care.

▸ Empowering and preparing patients to manage their health and health care, emphasizing the patient's central role in managing their health.

▸ Ensuring the delivery of effective clinical care and self-management support, such as providing clinical case management services for complex patients and giving care that patients understand and that fits with their cultural backgrounds.

▸ Promoting clinical care that's consistent with scientific evidence and patient preferences, embedding evidence-based guidelines into daily clinical practice.

▸ Organizing patient and population data to facilitate care, such as identifying subpopulations for proactive care, and sharing information with patients and providers to coordinate care.

Financial incentives and technology support for physicians are two “carrots” Medicare is testing to help improve chronic disease care for beneficiaries.

Primary care groups are collaborating with health care contractors to test a model of care that supports the physician's role in managing chronic disease.

The voluntary Medicare Chronic Care Improvement Program, a demonstration project created under the Medicare Modernization Act of 2003, is expected to reach about 180,000 fee-for-service Medicare beneficiaries with chronic health conditions such as complex diabetes or heart failure.

Not all details have been worked out, but the American College of Physicians and other primary care groups plan to work with two health care contractors “to find out how these models will work in the context of the project,” said Robert Doherty, ACP's senior vice president for governmental affairs and public policy.

Developed by Edward H. Wagner, M.D., an internist and epidemiologist, the chronic care model features an evidence-based team approach and physician incentives. It also emphasizes information technology and real-time decision support.

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions got the contract for Mississippi. Those companies were the only two that proposed the physician-guided, patient-centered model of care in their bids to Medicare, Mr. Doherty said.

The ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson. The company “is doing all the ground work on the project, but all three physician groups will serve as subcontractors,” Mary Frank, M.D., AAFP president, told this newspaper.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the firm “wanted to test a model that supports and enables the physician's care plan and strengthens the relationship between chronically ill patients and their doctors.” Slated to begin in June or September, the pilot test includes a chronic care management fee to recognize the time and effort involved in the initiative, he said. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans.”

The ACP plans to submit a white paper to Congress, outlining a more ambitious request to test the model in its entirety in a separate demonstration project, Mr. Doherty said. “We believe there should be a larger demonstration, to take the full components developed by Dr. Wagner” and test their effectiveness in smaller physician practices.

The ACP will be submitting the model along with a series of proposals that address broader payment issues for physicians. “Our sense is, we may need additional authority to test the model—that Congress should enact legislation to allow CMS to launch another demonstration project to allow full evaluation of the model,” Mr. Doherty said.

Primary Care Has Room to Improve

Primary care doctors have not been proactive in ensuring regular interactions with their chronically ill patients, according to Dr. Wagner.

Care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records,” he said at a healthy policy meeting last November.

Management of these patients usually relies on symptoms and lab results, not long-term disease control and prevention. “Most patients are receiving rushed admonitions to shape up, not counseling and supportive interventions that work,” said Dr. Wagner, who directs Improving Chronic Illness Care (ICIC), a national program of the Robert Wood Johnson Foundation.

The ACP white paper cited studies from the Institute of Medicine, Rand Corp., and CMS, showing that care for the chronically ill was fragmented and costly because of a lack of coordination under fee-for-service. This makes the large-scale testing of a patient-centered chronic care model “crucial to the health system's viability.”

Key elements of Dr. Wagner's model include:

▸ Mobilizing community resources to meet patient needs—for example, encouraging patients to participate in effective community programs.

▸ Reorganizing the health care system to encourage open and systematic handling of errors and quality problems to improve care and providing incentives to improve quality of care.

▸ Empowering and preparing patients to manage their health and health care, emphasizing the patient's central role in managing their health.

▸ Ensuring the delivery of effective clinical care and self-management support, such as providing clinical case management services for complex patients and giving care that patients understand and that fits with their cultural backgrounds.

▸ Promoting clinical care that's consistent with scientific evidence and patient preferences, embedding evidence-based guidelines into daily clinical practice.

▸ Organizing patient and population data to facilitate care, such as identifying subpopulations for proactive care, and sharing information with patients and providers to coordinate care.

Financial incentives and technology support for physicians are two “carrots” Medicare is testing to help improve chronic disease care for beneficiaries.

Primary care groups are collaborating with health care contractors to test a model of care that supports the physician's role in managing chronic disease.

The voluntary Medicare Chronic Care Improvement Program, a demonstration project created under the Medicare Modernization Act of 2003, is expected to reach about 180,000 fee-for-service Medicare beneficiaries with chronic health conditions such as complex diabetes or heart failure.

Not all details have been worked out, but the American College of Physicians and other primary care groups plan to work with two health care contractors “to find out how these models will work in the context of the project,” said Robert Doherty, ACP's senior vice president for governmental affairs and public policy.

Developed by Edward H. Wagner, M.D., an internist and epidemiologist, the chronic care model features an evidence-based team approach and physician incentives. It also emphasizes information technology and real-time decision support.

Health Dialog Services Corp. will run the project in Pennsylvania, and McKesson Health Solutions got the contract for Mississippi. Those companies were the only two that proposed the physician-guided, patient-centered model of care in their bids to Medicare, Mr. Doherty said.

The ACP, the American Academy of Family Physicians, and the American Geriatrics Society—will collaborate with McKesson. The company “is doing all the ground work on the project, but all three physician groups will serve as subcontractors,” Mary Frank, M.D., AAFP president, told this newspaper.

Sandeep Wadhwa, M.D., vice president of government programs at McKesson, said the firm “wanted to test a model that supports and enables the physician's care plan and strengthens the relationship between chronically ill patients and their doctors.” Slated to begin in June or September, the pilot test includes a chronic care management fee to recognize the time and effort involved in the initiative, he said. “We are also placing additional community- and office-based support” to improve adherence to physicians' treatment plans.”

The ACP plans to submit a white paper to Congress, outlining a more ambitious request to test the model in its entirety in a separate demonstration project, Mr. Doherty said. “We believe there should be a larger demonstration, to take the full components developed by Dr. Wagner” and test their effectiveness in smaller physician practices.

The ACP will be submitting the model along with a series of proposals that address broader payment issues for physicians. “Our sense is, we may need additional authority to test the model—that Congress should enact legislation to allow CMS to launch another demonstration project to allow full evaluation of the model,” Mr. Doherty said.

Primary Care Has Room to Improve

Primary care doctors have not been proactive in ensuring regular interactions with their chronically ill patients, according to Dr. Wagner.

Care of the chronically ill “is not planned, and it's dependent on the doctor, the doctor's memory, and disorganized written records,” he said at a healthy policy meeting last November.

Management of these patients usually relies on symptoms and lab results, not long-term disease control and prevention. “Most patients are receiving rushed admonitions to shape up, not counseling and supportive interventions that work,” said Dr. Wagner, who directs Improving Chronic Illness Care (ICIC), a national program of the Robert Wood Johnson Foundation.

The ACP white paper cited studies from the Institute of Medicine, Rand Corp., and CMS, showing that care for the chronically ill was fragmented and costly because of a lack of coordination under fee-for-service. This makes the large-scale testing of a patient-centered chronic care model “crucial to the health system's viability.”

Key elements of Dr. Wagner's model include:

▸ Mobilizing community resources to meet patient needs—for example, encouraging patients to participate in effective community programs.

▸ Reorganizing the health care system to encourage open and systematic handling of errors and quality problems to improve care and providing incentives to improve quality of care.

▸ Empowering and preparing patients to manage their health and health care, emphasizing the patient's central role in managing their health.

▸ Ensuring the delivery of effective clinical care and self-management support, such as providing clinical case management services for complex patients and giving care that patients understand and that fits with their cultural backgrounds.

▸ Promoting clinical care that's consistent with scientific evidence and patient preferences, embedding evidence-based guidelines into daily clinical practice.

▸ Organizing patient and population data to facilitate care, such as identifying subpopulations for proactive care, and sharing information with patients and providers to coordinate care.