Demonstration ProjectsAt QMed, we are pleased to be at the forefront of Medicare reform. The US government, through the Department of Health and Human Services, sponsors demonstration projects which test and introduce beneficial changes into the Medicare system. We are currently participating in 2 significant demonstration projects:
- Medicare Coordinated Care Demonstration (MCCD)
- Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA)
Both MCCD and BIPA are demonstrations in the largest component of Medicare's Fee-For-Service (FFS) group. These 2 demonstrations are designed to test whether Disease Management Programs can work as effectively in the Medicare FFS population, as they do in Health Maintenance Organizations (HMOs) and other managed-care settings. They will also provide the first randomized control studies of such programs.
Medicare Coordinated Care Demonstration (MCCD)
The Medicare Coordinated Care Demonstration (MCCD) is a 4-year demonstration project being conducted for Medicare Fee-For-Service (FFS) patients with chronic conditions. In this demonstration, we are focusing on improving whole health outcomes for patients who have a primary diagnosis of Coronary Artery Disease (CAD).
MCCD Objectives
MCCD is testing the cost-effectiveness of providing disease management programs versus usual care, sometimes called "standard-of-care" treatment, to patients with CAD.
Patient Participation
Over 1400 patients with CAD have been enrolled in MCCD since July 2002. Enrollment is concentrated in Stanislaus, San Joaquin, and Sacramento counties in California. Eligible patients are identified through claims and medical chart data from medical groups, hospitals, and physicians. After receiving approval from a patient's physician, a representative from QMed contacts the patient and explains the demonstration project. Patients who participate in this disease management randomized trial receive:
- Individualized health status assessments with one of our QMed nurses
- Financial assistance to ensure that heart medications prescribed are affordable and taken routinely as prescribed
- Ongoing education by our nurses designed to:
• Improve patient self-care and awareness
• Reduce hospitalizations through pro-active disease and
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- Increase coordination of care for those patients who do become ill
Randomization
All patients must sign a written consent or have a voice recording of an audible "yes response" before participating in a demonstration. Patients selected are randomly assigned to either the "Usual Care Group" or the "Disease Management Group" in a process called randomization. Having a randomized patient population has been shown to elicit the most unbiased results.
Differences Between the 2 Groups
The patients in the "Usual Care Group" receive their usual Medicare benefits, without any additional disease management programs we offer at QMed or from Medicare. The patients in the "Disease Management Group" receive their usual Medicare benefits and in addition receive our disease management programs.
All participants remain under the care of their own physician no matter which group they are assigned. In addition, all patients continue to have the same right to access medical services as they currently have in their Medicare program. Participation is completely voluntary and Medicare benefits are not affected if a patient declines to participate.
Early Demonstration Results
Preliminary outcomes are suggesting:
- Marked improvement in quality indicators showing an increase in the use of post-myocardial infarction (heart attack) medications, lipid (cholesterol) lowering drugs and preventative exams, and tests above national benchmarks.
- Increased physician compliance to quality goals many of which are above national benchmarks
- Over 92% patient satisfaction rate
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Disease Management Demonstration
The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Disease Management Demonstration currently being conducted is designed to evaluate the effectiveness of disease management programs when combined with a prescription drug benefit. Specifically under study is whether health outcomes are improved when Medicare patients, either as hospital inpatients or ambulatory patients with advanced-stage congestive heart failure, diabetes, or coronary heart disease, utilize disease management programs combined with a prescription drug benefit.
At QMed, we participate in BIPA through our HeartPartners project, which is jointly operated by QMed, PacifiCare Health Systems and Alere Medical. HeartPartners patients all suffer from Congestive Heart Failure, a chronic debilitating disease also associated with very high financial costs.
BIPA Objectives
This demonstration provides disease management programs and a comprehensive prescription drug benefit to certain severely chronically ill patients. The objective is to test whether disease management programs in the traditional fee-for-service (FFS) group leads to improved outcomes and to lower total costs to Medicare.
Patient Participation
Enrollment began in January of 2004, and up to 30,000 eligible Medicare FFS patients with diagnosed, advanced stage congestive heart failure, diabetes, or coronary artery disease may be eligible to participate in the treatment arm of the study. Recruitment for this 3-year study is limited to Medicare patients throughout California, Arizona, and parts of Louisiana and Texas.
Prescription Drug Benefit
The project includes coverage of most prescription drugs, even those not related to the patient's study condition. Patients are subject to a modest co-payment for their prescription medication.
Randomization
All patients must sign a written consent or have a voice recording of an audible "yes response" before participating in a demonstration. Patients are then randomly assigned to either the "Usual Care Group" or the "Disease Management Group" in a process called randomization. Having a randomized patient population participating in a demonstration has been shown to elicit the most unbiased results.
Differences Between the 2 Groups
The patients in the "Usual Care Group" receive their usual Medicare benefits, without any additional prescription drugs or disease management programs we offer at QMed. The patients in the "Disease Management Group" receive their usual Medicare benefits in addition to the prescription drug benefit and disease management programs we provide.
All participants remain under the care of their own physician no matter which group they are assigned. In addition, all patients continue to have the same right to access medical services as they currently have in their Medicare program. Patient participation is completely voluntary and Medicare benefits are not affected if a patient declines to participate.
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