Findings from Chronic Care Pilot Published

RTI International published the first interim report evaluating (pdf) the recently implemented Chronic Care Improvement Pilot Project by the Centers for Medicare and Medicaid Services (CMS). The first report contains data from the first six months of programming. The goal of the program is to decrease cost of care through implementation of holistic disease management programs for chronic health conditions.

Eight of the Medicare Health Support Organizations (MHSO) commenced programmiong during a five month period that started at the end of 2005, after receiving grant awards to participate. Importantly, considering that this is the first interim analysis, there was a delay before patients commenced participation and the program launches. Less data and a shorter duration of programming limit the ability to draw broad conclusions about this effort.

The team did noted significant variation amongst those who did versus did not opt to participate. Patients who chose to participate were generally healthier and had fewer co-morbidities than those who opted not to participate. However, stratification matching which included three factors was undertaken during random assignment.

This early analysis revealed limited difference with respect to acute care utilization comparing the groups. So, too, were differences noted in the rate of average per-beneficiacy-per-month during the time period between patient randomization and when programming actually commenced.

This is relevant in terms of program design and assessment of cost savings. The interim period is included in the analysis of cost savings associated with the chronic care efforts. The cost elevation at the start may need to be removed from analyses to assess the program costs representing programming exclusively.

Cost comparisons between those who agreed to participate versus those who did not reveal decreased costs for the non-intervention group. This also needs to be addressed in the program design because total cost savings is the program objective and non-participants may be skewing the data; they are noted to be sicker. The impact of this intervention on costs requires a revision to analysis approaches. As the current findings reveal, there is no cost benefit noted.

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