This demonstration tests whether providing coordinated care services to Medicare beneficiaries with complex chronic conditions can 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 can yield better patient outcomes without increasing program costs. The selected projects represent a wide range of programs, use both case and disease management approaches, and operate 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 requires that the projects target chronically ill Medicare fee-for-service beneficiaries that are eligible for both Medicare Parts A and B. At least nine sites must be selected, with at least five of the selected sites targeting urban areas and three sites targeting rural areas. In addition, one site must be 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 requires that the projects’ payment methodology be budget neutral. Finally, CMS must submit a Report to Congress every two years following implementation. The HHS Secretary, through regulations, can make components of the demonstration that are found to be cost-effective a permanent part of the Medicare program and expand the number of demonstration projects.
CMS will conduct a formal evaluation of the demonstration every two years after implementation and report to Congress on its findings. The evaluation will assess 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 are being funded for 4 years. If CMS’s formal evaluation finds that the projects are cost-effective and that quality of care and satisfaction are improved, the effective projects shall be continued, and the number of projects may be expanded. In addition, the components of the effective projects that are beneficial to the Medicare program may be made a permanent part of the Medicare program.
Additional Information
- The Evaluation of the Medicare Coordinated Care Demonstration: Findings for the First Two Years (PDF)
- Summary (PDF)
- Fact Sheet (PDF)
- Solicitation (PDF)
- Medicare Fact Sheet (PDF)
- Medicare Fact Sheet (ZIP)
- Press Release (PDF)
- Program Memorandum (PDF)
- Solicitation (PDF)
- Executive Summary (PDF)
- Best Practices in Coordinated Care Report (PDF)
- Request Information (PDF)
- Request Information (ZIP)
- Section 4016 of the Balanced Budget Act (B.B.A.) of 1997 (PDF)
- Coordinating Care for Medicare Beneficiaries: Early Experiences of 15 Demonstration Programs, Their Patients, and Providers (PDF)
