Medicaid, State Finances, and the Bottom Line for Businesses

Current Medicaid expenditures account for about nine percent of the federal budget and almost a quarter of state budgets and are growing rapidly. State Medicaid budgets are especially vulnerable to recession since states cannot incur large and sustained fiscal deficits. Without change, Medicaid burdens will cause state finances to be diverted from infrastructure and education, with negative effects on the costs and productivity of business. Also affecting business are the state governments experimenting with policies that shift Medicaid burdens to private employers. Simultaneously, the states are initiating efforts to ease Medicaid's relentless cost increases and address its long-run problems.Business Economics (2006) 41, 49–54; doi:10.2145/20060306

Medicaid Disease Management Programs: Findings from Three Leading US State Programs

Disease management emphasizes prevention of disease-related exacerbations and complications using evidence-based guidelines and patient empowerment tools. It can help manage and improve the health status of a defined patient population over the entire course of a disease. More than 20 states in the US are developing and implementing Medicaid disease management programs. While most are in an early stage of development, a small number of states were pioneers in disease management and have already gained much insight. Among them, three states - Florida, Virginia, and West Virginia - provide some significant lessons. In the late 1990s, Florida The Virginia Health Outcomes Project was shown to be effective in reducing use of emergency and urgent care services by Medicaid patients with asthma (average 42% reduction in the third to fifth quarters after introduction of the program) and increasing the appropriate use of asthma medications. It was also shown to be cost effective, with projected direct savings to Medicaid of $US3-5 (2002 values) for every incremental dollar spent providing disease management support to physicians. The goals of the West Virginia Health Initiatives Project were to deliver quality care, improve health status and quality of life, and ensure the efficient and appropriate utilization of resources for Medicaid patients with diabetes. The model program had two critical components: (i) adaptation of clinical treatment guidelines that are in the public domain to blend the highest quality of care with the best practical management strategies; and (ii) feedback reports that provide real-time data about patients It would be a mistake to attempt to draw firm conclusions about disease management programs for low-income elderly or physically disabled patients in the US Medicaid program given their current stage of development. However, credit should be given to the states that are experimenting with cutting-edge programs to tackle not only their fiscal issues, but perhaps more importantly, the issue of ensuring high-quality, cost-effective healthcare for the patients they serve.Disease-management-programmes, Evidence-based-medicine

Evaluation Of Chronic Disease Management On Outcomes And Cost Of Care For Medicaid Beneficiaries

Objectives: To evaluate the impacts of the chronic disease management program on the outcomes and cost of care for Virginia Medicaid beneficiaries. Methods: A total of 35,628 patients and their physicians and pharmacists received interventions for five chronic diseases and comorbidities from 1999 to 2001. Comparisons of medical utilization and clinical outcomes between experimental groups and control group were conducted using ANOVA and ANCOVA analyses. Results: Findings indicate that the disease state management (DSM) program statistically significantly improved patient\u27s drug compliance and quality of life while reducing (ER), hospital, and physician office visits and adverse events. The average cost per hospitalization would have been $42 higher without the interventions. Conclusions: A coordinated disease management program designed for Medicaid patients experiencing significant chronic diseases can substantially improve clinical outcomes and reduce unnecessary medical utilization, while lowering costs, although these results were not observed across all disease groups. The DSM model may be potentially useful for Medicaid programs in states or other countries. If the adoption of the DSM model is to be promoted, evidence of its effectiveness should be tested in broader settings and best practice standards are expected. © 2007 Elsevier Ireland Ltd. All rights reserved

Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries

Objectives To evaluate the impacts of the chronic disease management program on the outcomes and cost of care for Virginia Medicaid beneficiaries.Methods A total of 35,628 patients and their physicians and pharmacists received interventions for five chronic diseases and comorbidities from 1999 to 2001. Comparisons of medical utilization and clinical outcomes between experimental groups and control group were conducted using ANOVA and ANCOVA analyses.Results Findings indicate that the disease state management (DSM) program statistically significantly improved patient's drug compliance and quality of life while reducing (ER), hospital, and physician office visits and adverse events. The average cost per hospitalization would have been $42 higher without the interventions.Conclusions A coordinated disease management program designed for Medicaid patients experiencing significant chronic diseases can substantially improve clinical outcomes and reduce unnecessary medical utilization, while lowering costs, although these results were not observed across all disease groups. The DSM model may be potentially useful for Medicaid programs in states or other countries. If the adoption of the DSM model is to be promoted, evidence of its effectiveness should be tested in broader settings and best practice standards are expected.