Medicaid Reform and Disease Management in Florida

Over the past 25 years, the United States has seen an explosion in health care costs with parallel concerns regarding quality and safety of patient care. With over 90 million Americans living with chronic illness, annual health care spending has topped $1.5 trillion. Nearly 75% of expenditures are attributable to chronic disease, with up to 60% related to modifiable health behaviors. Proactive management or prevention of chronic conditions represents the single largest opportunity to improve health and contain costs. Disease management (DM), a multidisciplinary system of coordinated interventions emphasizing patient self-management, has been shown to be an effective approach to managing chronically ill patients. Florida: A Healthy State was launched in 2001 as a partnership between the State of Florida and Pfizer Inc to reduce rapidly growing health care costs by improving the health of chronically ill Medicaid beneficiaries. Together, through a statewide network of community hospitals, civic organizations, consumer and patient advocacy groups and physicians, Florida's Agency for Health Care Administration and Pfizer designed a program to provide disease management, new health benefits, and support to Medicaid beneficiaries statewide. With the help of this new care network, participants changed behaviors through coaching, education and personal intervention. Having touched over 180,000 lives, we have celebrated significant improvements in behavioral, clinical, process and utilization metrics which will be presented at this session.