Medicare Coordinated Care Demonstration

This demonstration tested whether providing coordinated care services to Medicare beneficiaries with complex chronic conditions could yield better patient outcomes without increasing program costs.

Background

The Centers for Medicare & Medicaid Services (CMS) selected 15 sites for a pilot project to test whether providing coordinated care services to Medicare fee-for-service beneficiaries with complex chronic conditions could yield better patient outcomes without increasing program costs. The selected projects represented a wide range of programs, used both case and disease management approaches, and operated in both urban and rural settings.

Initiative Details

The coordinated care demonstration was authorized by Section 4016 of the Balanced Budget Act of 1997 (BBA). The BBA required that the projects target chronically ill Medicare fee-for-service beneficiaries that were eligible for both Medicare Parts A and B. At least nine sites must have been selected, with at least five of the selected sites targeting urban areas and three sites targeting rural areas. In addition, one site must have been in the District of Columbia operated by an academic medical center with a comprehensive cancer center certified by the National Cancer Institute. The BBA also required that the projects’ payment methodology be budget neutral. Finally, CMS must have submitted a Report to Congress every two years following implementation. The HHS Secretary, through regulations, could make components of the demonstration that were found to be cost-effective a permanent part of the Medicare program and expand the number of demonstration projects.

CMS conducted a formal evaluation of the demonstration every two years after implementation and reported to Congress on its findings. The evaluation assessed health outcomes and beneficiary satisfaction, the cost-effectiveness of the projects for the Medicare program, provider satisfaction, and other quality and outcomes measures.

The initial projects were funded for 4 years. If CMS’s formal evaluation were to find that the projects are cost-effective and that quality of care and satisfaction were improved, the effective projects would be continued, and the number of projects might be expanded. In addition, the components of the effective projects that are beneficial to the Medicare program might be made a permanent part of the Medicare program.

Additional Information