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Medicare's Chronic Care Improvement Pilot Program: What Is Its Potential?

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The recent Medicare law puts into motion sweeping changes to the nearly 40-year-old program, from instituting a new prescription drug benefit to redesigning and renaming Medicare+Choice as Medicare Advantage. Among its many far-reaching provisions, the law also aims to improve chronic care for Medicare beneficiaries by establishing several new programs and pilot projects.

This fact sheet summarizes the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 that relate to chronic care improvement under fee-for-service Medicare (section 721). The authors examine the emerging issues raised by this new program, called the Chronic Care Improvement Program (and since renamed "Medicare Health Support"), including which chronic conditions should be targeted, the types of entities that may participate, the physician's role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.

The fact sheet is a summary of the longer issue brief prepared by the National Health Policy Forum, which is available through the link below. California will not be included in the initial pilot program. The BIPA Disease Management programs are underway and are enrolling beneficiaries with similar characteristics as CCIP-eligible beneficiaries. CMS may issue another solicitation at a future time for programs in this area.

On December 8, 2004, nine organizations were selected to operate three-year pilot programs under this program. The programs will be phased in during the spring of 2005.