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Medicare Faces Challenges Caring for Chronically Ill

ByABC News
February 10, 2009, 7:01 PM

Feb. 11 -- TUESDAY, Feb. 10 (HealthDay News) -- Only a fraction of Medicare pilot programs aimed at cutting costs and improving care for people with chronic illness actually did the job, a new study shows.

That doesn't necessarily mean that ideas like these should be abandoned altogether, however.

Based on the findings, "we should not expect these care coordination efforts to pay for themselves or to save money," said Paul Precht, director for policy and communications at the Medicare Rights Center. "But that doesn't mean they're not worth doing, because when they work right, they can deliver better health for people."

And what makes them work right?

"If you target the programs well on people who have the right level of severity of illness and types of illnesses, and you have certain features, then you can have an impact on hospitalization rates. That's the key," said study senior author Randall Brown, vice president and director of health research at Mathematica Policy Research Inc. in Princeton, N.J. Mathematica designed this pilot project.

"The more that providers and particularly the physicians are directly involved and the more the physicians are part of an integrated network that includes the other specialties, the better [a particular program] works," added Precht.

The findings were published in the Feb. 11 issue of the Journal of the American Medical Association.

Most experts agree that exploding costs and the prospect of an empty purse threaten Medicare's future. According to an accompanying editorial, Medicare expenditures will top $400 billion this year, a hefty 13 percent of the total federal budget.

One study found that in 2002, about half of beneficiaries who had been treated for five or more conditions accounted for 75 percent of total spending.

Most of the costs associated with chronic illness come from hospital stays which, in turn, are often due to inadequate care between admissions (lack of counseling on improving lifestyle factors, lack of adherence to medication regimens, etc.).