The congressionally mandated Medi care Coordinated Care Demonstration (MCCD) is among the first random as signment multisite studies of care coordi nation. It tests specifically whether care coordination and DM can lower costs and improve patient outcomes and well being for Medicare FFS
Fee-for-service
Fee-for-service is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. However evidence of the effectiveness of pay-for-performance in improving health care quality is mixed, without conclusive proof that these programs either succe…
What is the Coordinated Care demonstration?
MEDICARE COORDINATED CARE DEMONSTRATION 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
Can Coordinated Care improve outcomes for Medicare beneficiaries with complex chronic conditions?
Mar 21, 2007 · As required under the Balanced Budget Act of 1997, the U.S. Secretary of Health and Human Services commissioned the Medicare Coordinated Care Demonstration to pilot and evaluate care coordination programs in the Medicare fee-for-service setting. The Centers for Medicare & Medicaid Services (CMS) contracted with Mathematica to evaluate the Medicare …
What can the HHS Secretary do to improve the demonstration program?
Aug 31, 2020 · Medicare Coordinated Care Demonstration (MCCD) – Override of certain Medicare Secondary Payer Edit Codes. Guidance for a change that will enable the demonstration carrier, NHIC, to allow payment of demonstration related claims for beneficiaries who are enrolled in the demonstration under an active Notice of Election but who, subsequent to being enrolled in the …
How many coordinated care entities (CCES) will there be?
Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. As policy makers seek to slow the growth in Medicare spending, they have appropriately focused attention on beneficiaries with multiple chronic conditions. Many care coordination and disease management programs designed to improve beneficiaries' care and …
What is a Medicare demonstration project?
Demonstration projects allow the Centers for Medicare & Medicaid Services (CMS) to test and measure the likely effects of potential program changes, including new methods of service delivery, coverage for new types of services, and new payment approaches.
What is a coordinated care plan?
A coordinated care plan is a classification of Medicare Advantage plans. They are provided by private insurance companies. Medicare coordinated care plans include health maintenance organizations, preferred provider organizations, Special Needs Plans and HMOs with a point-of-service option.
Why is coordinated care important?
The goals of coordinated care are to improve health outcomes by ensuring that care from disparate providers is not delivered in silos, and to help reduce health care costs by eliminating redundant tests and procedures.Jan 1, 2018
What is the purpose of care coordination?
The main goal of care coordination is to meet patients' needs and preferences in the delivery of high-quality, high-value health care.
What is coordinated care demonstration?
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.
How often does CMS conduct a demonstration?
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.
Evidence & Insights From This Project
Care for beneficiaries with chronic illnesses, such as heart disease and diabetes, is a major expense to the Medicare program, and a major detriment to beneficiaries’ quality of life.
The Evaluation of the Medicare Coordinated Care Demonstration: Findings for the First Two Years
Care for beneficiaries with chronic illnesses, such as heart disease and diabetes, is a major expense to the Medicare program, and a major detriment to beneficiaries’ quality of life.
How does CMS work with Massachusetts?
CMS and Massachusetts will work together to ensure there are multiple communication points for providing understandable information to beneficiaries. Clear notices – at multiple points and times – will be required to ensure that beneficiaries know of their benefits, rights, and choices and can make an informed decision about whether to remain in the assigned plan, choose a different plan, or opt-out. In addition, CMS has announced, in concert with the Administration for Community Living, a new funding opportunity to support outreach, education and counseling for Medicare-Medicaid enrollees eligible for the new programs through the State Health Insurance Programs (SHIPs) and the Aging and Disability Resource Centers (ADRCs).
Can Medicare enrollees opt out of Massachusetts?
Medicare-Medicaid Enrollees who are not eligible for passive enrollment with an opt-out, but who may participate in the Massachusetts Demonstration if they choose to disenroll from their existing programs, include:
Does CMS monitor the demonstrations?
Yes. CMS is funding and managing the evaluation of each state Demonstration. CMS has contracted with an external independent evaluator, RTI International, to measure, monitor, and evaluate the overall impact of the Demonstrations, including impacts on Medicare and Medicaid expenditures and service utilization. There will be a unique, Massachusetts-specific evaluation plan for the Demonstration, as well as a meta-analysis that will look at the Demonstration overall.
