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Medicare Compliance & Reimbursement

Disease Management:

TRIO OF HEALTH PLANS TAPPED FOR MEDICARE DM PILOT

Published on Thu Dec 11, 2003

Will disease management find a happy home in Medicare?  Health plans that haven't yet jumped into disease management may want to make the move soon - the Centers for Medicare & Medicaid Services is pushing to find out how DM should work in Medicare, and the fruits of a series of pilot projects could lay the groundwork for the future. In the latest development, CMS Nov. 18 unveiled the names of three organizations tapped to take part in a pilot aimed at chronically ill Medicare patients suffering from heart problems and complex diabetes. Rosemont, IL-based CorSolutions, Diabetex/XLHealth of Baltimore and Santa Ana, CA-based HealthPartners SM will recruit up to 30,000 Medicare beneficiaries in California, Arizona, Louisiana and Texas for the project, under which Medicare will provide payment for all disease management services - not just those related to the beneficiaries' chronic conditions - along with prescription drug costs. CMS aims to figure out how DM can help improve outcomes for Medicare fee-for-service patients without increasing costs. Express Scripts will provide pharmacy benefit services for CorSolutions, PBM Plus for Diabetex/XL Health and Pacificare's Prescription Solutions for HealthPartners SM. The pilot is only the latest in a series of initiatives launched by CMS in recent years. Other ongoing projects have targeted patients with congestive heart failure, chronic obstructive pulmonary disease and other conditions. Lesson Learned: Providers of DM services could have big opportunities in store as CMS probes for ways to make it work in Medicare.
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