Results of the Medicare Health Support disease-management pilot program

N Engl J Med. 2011 Nov 3;365(18):1704-12. doi: 10.1056/NEJMsa1011785.


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.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Chronic Disease / nursing
  • Cost Savings*
  • Delivery of Health Care / statistics & numerical data
  • Diabetes Complications / therapy
  • Diabetes Mellitus / therapy*
  • Disease Management*
  • Emergency Service, Hospital / statistics & numerical data*
  • Fee-for-Service Plans / economics*
  • Fees, Medical
  • Heart Failure / complications
  • Heart Failure / therapy*
  • Hospitalization / statistics & numerical data
  • Humans
  • Insurance, Health / economics
  • Medicare / economics*
  • Pilot Projects
  • Quality of Health Care
  • United States