Perspective               

Medicare Overhaul Bill Promotes Disease Management and Chronic Care Programs

The recently passed Medicare overhaul legislation promotes disease management and other chronic care programs for older and disabled individuals with chronic illnesses such as diabetes, heart disease, asthma, and high blood pressure. If you have one of these or another chronic illness, you may be able to get increased help managing your condition.

Increased monitoring is intended to prevent medical crises that could send patients to the hospital and cost the government much more than it would to treat the original condition. The government hopes to enroll as many as 400,000 older and disabled people with chronic conditions in monitoring programs. By involving the patient, physicians, pharmacists, and other providers in commonsense steps to improve patient health, Medicare will be able to avert medical disasters before they happen.

The chronic care effort is new in the Medicare system, which traditionally has sought to treat diseases, not prevent them. The new legislation, along with the care management provision, entitles new enrollees in Medicare to a physical examination and other new preventive treatments. This expansion of Medicare’s original purpose reflects increases in the number of people with chronic conditions. According to the Medicare Payment Advisory Commission, three-fourths of people with Medicare have at least one chronic condition, and close to one-third have four or more. These people account for 80 percent of Medicare spending.

The new chronic care initiative will be piloted in ten regions of the country that cover a total of about four million clients. The government will contract with private companies, which will sign up patients and take charge of coordinating care. Two of the biggest obstacles for these companies will be persuading people with chronic conditions to enroll in disease management programs and coordinating care among a dozen or more doctors who may be treating patients with several illnesses. If such obstacles can be overcome and the pilot is successful, the model will be rolled out to the rest of the country.

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