The Quality of Health Care
Disease Management in Fee-for-Service Medicaid Programs
Research Report
Lynda Flowers, AARP Public Policy Institute
March 2007
Faced with growth in Medicaid spending, State Medicaid programs are turning to disease management (DM) as a way potentially to reduce program costs and improve quality of care and health outcomes among fee-for-service Medicaid populations. Intended primarily to inform state policymakers and program administrators seeking to establish DM programs, this AARP Public Policy Institute Issue Brief focuses on DM program design options and the challenges associated with the development, implementation and evaluation of DM programs in fee-for-service Medicaid.
- In 2001, chronic diseases--such as asthma, heart disease, and diabetes--accounted for 78 percent of the nation’s health spending and 80 percent of state Medicaid resources. They affected the quality of life of 125 million Americans.
- The management of multiple chronic illnesses often requires several health care practitioners and multiple prescription drugs. Consequently, affected persons are at high risk for fragmented care, adverse prescription drug interactions, confusion about their care, multiple and costly hospitalizations, and poor health outcomes.
- The disease management approach involves improvements in care coordination, controlling costs through the integration of components across the entire delivery system, and the use of targeted interventions.
While it is still too early to judge their effectiveness, this Issue Brief discusses the potential of DM programs, specifies the authority and funding for them, describes major program components, and charts the perceived advantages and disadvantages of the three currently-employed program design options.
Pub ID: IB81