Congestive heart failure disease management in Medicare-managed care.

BACKGROUND

In 2001, the Center for Medicare and Medicaid Services began 2 initiatives that encouraged Medicare-managed care plans to introduce congestive heart failure (CHF) disease management programs. Our study was designed to describe the use, structure, and content of these programs.

METHODS

In 2003 to 2004, we invited the representatives of Medicare-managed care plans with > or = 750 enrollees to participate in a survey by mail or telephone.

RESULTS

Representatives of 120 plans, 84 (70%) responded. Of the plans, 92% had CHF programs, 45% of which were instituted in 2001 or later, and 42% of which were handled externally by commercial vendors. Vendor use was more common in large programs (> 30,000 Medicare enrollees) than in small programs (< 15,000 Medicare enrollees) (57% vs 24%, P = .05), in national than local programs (50% vs 21%, P = .03), and in for-profit than not-for-profit programs (45% vs 21%, P = .03). Although 87% of CHF programs focused on improving patient self-management, a smaller fraction engaged practicing physicians (eg, 23% provided feedback to physicians concerning whether care was consistent with CHF guidelines).

CONCLUSIONS

In Medicare-managed care plans, there is widespread use of CHF disease management. However, the programs used primarily focus on patient self-management and not on engaging physicians on medication management and compliance with guidelines. Our findings raise the concern that these programs will not be able to achieve the quality improvement and cost savings previously demonstrated in clinical trials of CHF disease management.