Medicare Health Support ResourcesSection 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) created the "Voluntary Chronic Care Improvement Program," now called Medicare Health Support (MHS), to improve the quality of care and lives of targeted chronically ill beneficiaries enrolled in traditional fee-for-service Medicare, while also providing net savings to the Medicare program. DMAA believes that Phase I of the Medicare Health Support program will demonstrate the benefits—including financial and clinical outcomes, as well as patient and provider satisfaction—disease management programs can provide for chronically ill populations in the Medicare program. Phase I participating organizations ("awardees") are being paid a monthly per-beneficiary fee for managing a population with congestive heart failure or complex diabetes, or both. All Phase I awardees have guaranteed Medicare a net savings of at least 5 percent compared with a similar, non-intervention, or control group population of beneficiaries. Phase I awardees also have guaranteed improvements in quality and beneficiary and provider satisfaction. The MHS program represents a fundamental shift in the way the Centers for Medicare and Medicaid Services (CMS) pays for health care. Traditionally, Medicare has paid and rewarded providers for the delivery of units of service. Through Medicare Health Support, CMS has embraced a population-based model that pays for pre-defined and measurable outcomes within a business framework that holds awardees accountable for achieving positive results.
MHS is, therefore, one of CMS's most robust pay-for-performance initiatives, and its early success is evidence that CMS is carrying out the MMA's vision to modernize the program to meet the needs of beneficiaries and providers for the 21st century. Broadly conducted, the MHS program promises to be a flexible and dynamic vehicle for CMS to use to pay for improving quality and to meaningfully reduce overall medical trend in traditional fee-for-service Medicare. DMAA has developed policy statements on various aspects of Medicare Health Support:
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