To prepare for the aging of our population, managed care organizations (MCOs) must anticipate elderly members’ medical and social needs and provide services that improve well-being, slow functional decline, and reduce avoidable health resource use.
An 18-month trial will examine whether population-based outcomes management can enhance health care quality and manage costs by targeting the preventable burden of disease and disability in the elderly. Ten thousand Medicare managed care members (ages 65+), continuously enrolled for at least one year, were randomly assigned by place of residence to the intervention or control group (usual care).
Prior to the January 2000 launch of interventions, claims data were analyzed to identify objectives for health maintenance/improvement. Targets include: prevention of falls and fractures; screening and treatment for depression; automated drug utilization review to detect and rectify potentially inappropriate prescribing; identification and amelioration of nutritional deficits; and implementation of disease management for congestive heart failure and diabetes. With links to community resources, nurse care coordinators (for members with multiple conditions) and personal service representatives (for healthier members) implement specific interventions to meet each objective.
The MCO’s innovative information systems allow staff to collect and review integrated data regarding members’ medical encounters, prescription drug use, lab results, perceived health status, and major life events (e.g., loss of spouse or loved one; change in living arrangement). Screening and intervention protocols are triggered by automated decision rules. We will review early data regarding the potential for Medicare MCOs to improve the health and well-being of the elderly.
Learning Objectives: After participating in this session, attendees will be able to: 1) Describe the health status of a Medicare managed care population, using key indicators of health resource consumption and standardized survey measures (like the Medical Outcomes Study Short Form-36). 2) Identify key components of the preventable burden of disability and disease in a Medicare managed care population. 3) Conceptualize institutional strategies (including technology solutions) to support health improvement in a managed care organization
Keywords: Disease Management, Quality of Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Support for this study is provided by Coventry Health Care and Merck and Co., Inc
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: The co-authors are employees of Merck and Co., Inc. and Coventry Health Care.