Medicaid populations can benefit from DM interventions

November 1, 2004

As the spiraling cost of healthcare continues to strain federal and state budgets, state Medicaid agencies are looking for powerful, workable solutions to the crisis.

As the spiraling cost of healthcare continues to strain federal and state budgets, state Medicaid agencies are looking for powerful, workable solutions to the crisis. Alternatives are needed that do not reduce benefits or tighten eligibility requirements for a population that largely relies on Medicaid as its only source of healthcare coverage.

A successful disease management (DM) program can help stem the rising tide of medical costs. The primary mission of DM is to help individuals with chronic illness reach optimal health while reducing medical costs. By supporting the patient-physician relationship and educating individuals on how to take more responsibility for their health, DM can help prevent costly hospitalizations and emergency department visits.

SUNSHINE STATE'S DM EFFORTS LifeMasters and Florida's Agency for Health Care Administration (AHCA) have worked together since September 2000 in one of the industry's first public-private collaborations, providing Medicaid beneficiaries in northern Florida with DM services for congestive heart failure and all related conditions and comorbidities, including diabetes, COPD, hypertension and depression.

Despite this higher cost, Medicaid DM programs will still generate a positive return on investment (ROI) because of the higher level of program acceptance and adherence by beneficiaries and their physicians, and the lack of other coordination-of-care efforts directed toward the population.

The LifeMasters/AHCA DM program works and proves that DM can take on the multilayered challenges of access, quality, cost, and care coordination with low-income population-and reap millions of dollars of savings in the process. As a result, LifeMasters and AHCA were honored with the 2004 AstraZeneca-National Managed Health Care Congress Partnership Award, which recognizes organizations that demonstrate quality, access, and efficiency of healthcare delivery through the cooperation and collaboration of organizations.

This section is underwritten by an unrestricted editorial grant from NMHCC.