Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Nov 3;365(18):1704-12.
doi: 10.1056/NEJMsa1011785.

Results of the Medicare Health Support Disease-Management Pilot Program

Affiliations
Free article
Randomized Controlled Trial

Results of the Medicare Health Support Disease-Management Pilot Program

Nancy McCall et al. N Engl J Med. .
Free article

Abstract

Background: In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program.

Methods: The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries.

Results: The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures.

Conclusions: In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.

Comment in

  • Medicare Health Support Pilot Program.
    Terry DF, Moisuk S. Terry DF, et al. N Engl J Med. 2012 Feb 16;366(7):666; author reply 667-8. doi: 10.1056/NEJMc1114006. N Engl J Med. 2012. PMID: 22335752 No abstract available.
  • Medicare Health Support Pilot Program.
    Krakauer R, Spettell C, Reisman L. Krakauer R, et al. N Engl J Med. 2012 Feb 16;366(7):666-7; author reply 667-8. doi: 10.1056/NEJMc1114006. N Engl J Med. 2012. PMID: 22335753 No abstract available.
  • Medicare Health Support Pilot Program.
    Clark AM, Thompson DR. Clark AM, et al. N Engl J Med. 2012 Feb 16;366(7):667. doi: 10.1056/NEJMc1114006. N Engl J Med. 2012. PMID: 22335754 No abstract available.
  • Medicare Health Support Pilot Program.
    King G, Nielsen R, Wells A. King G, et al. N Engl J Med. 2012 Feb 16;366(7):667; author reply 667-8. doi: 10.1056/NEJMc1114006. N Engl J Med. 2012. PMID: 22335755 No abstract available.

Similar articles

See all similar articles

Cited by 35 articles

See all "Cited by" articles

Publication types

MeSH terms

LinkOut - more resources

Feedback