As the spiraling cost of healthcare continues to strain federal and state budgets, state Medicaid agencies are looking for
powerful, workable solutions to the crisis. Alternatives are needed that do not reduce benefits or tighten eligibility requirements
for a population that largely relies on Medicaid as its only source of healthcare coverage.
A successful disease management (DM) program can help stem the rising tide of medical costs. The primary mission of DM is
to help individuals with chronic illness reach optimal health while reducing medical costs. By supporting the patient-physician
relationship and educating individuals on how to take more responsibility for their health, DM can help prevent costly hospitalizations
and emergency department visits.
SUNSHINE STATE'S DM EFFORTS LifeMasters and Florida's Agency for Health Care Administration (AHCA) have worked together since September 2000 in one of
the industry's first public-private collaborations, providing Medicaid beneficiaries in northern Florida with DM services
for congestive heart failure and all related conditions and comorbidities, including diabetes, COPD, hypertension and depression.
Today, more than 8,000 patients have benefited from the LifeMasters/AHCA DM program, which has saved '12.6 million in its
first two years, representing a 16.3% decline in healthcare costs. This figure includes a 36% reduction of hospital admissions
for Medicaid patients. In addition to significant cost savings achieved by the state, there has been a markedly improved quality
of life for thousands of chronically ill Floridians. The program now serves as a model. Lessons learned during the first two
years of the AHCA Program include:
- Medicaid DM programs are more costly to provide than programs directed at commercial populations because of the need to adapt
to the special needs of beneficiaries, to provide a more intense level of services, to maintain an on-the-ground local presence,
and to integrate with the existing provider and social service infrastructure.
Despite this higher cost, Medicaid DM programs will still generate a positive return on investment (ROI) because of the higher
level of program acceptance and adherence by beneficiaries and their physicians, and the lack of other coordination-of-care
efforts directed toward the population.
- Outreach and enrollment efforts must be more creative and proactive than in commercial DM programs because of the mobile nature
of the population, lower levels of telephone service, and literacy and language barriers in the beneficiary population.
- Population-based programs that focus on multiple chronic conditions and their comorbidities will generate the highest long-term
ROI and the least administrative burden for Medicaid, managed care plans and agencies.
The LifeMasters/AHCA DM program works and proves that DM can take on the multilayered challenges of access, quality, cost,
and care coordination with low-income population—and reap millions of dollars of savings in the process. As a result, LifeMasters
and AHCA were honored with the 2004 AstraZeneca-National Managed Health Care Congress Partnership Award, which recognizes
organizations that demonstrate quality, access, and efficiency of healthcare delivery through the cooperation and collaboration
of organizations.
This section is underwritten by an unrestricted editorial grant from NMHCC.
