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Prepared Witness Testimony The House Committee on Energy and Commerce
Evaluating Coordination of Care in Medicaid: Improving Quality and Clinical Outcomes.
Subcommittee on Health
Dr. Rhonda Medows
Good Morning, Chairman Bilirakis, Representative Brown, and Members of the Committee. Thank you for this opportunity to address the Committee on improving quality and clinical outcomes through disease management in the Medicaid program. I am Dr. Rhonda Medows, Secretary for Florida's Agency for Health Care Administration (AHCA)-the state agency that directly oversees the Medicaid program. Today, I will briefly highlight a number of innovative Medicaid disease management programs in Florida. As you learned from the testimony of Governor Bush earlier this year, Florida's Medicaid program is the nation's fourth largest. We serve more than two million people and manage a $12.7 billion budget. Disease management in Florida is a pioneering effort to coordinate treatment efforts and improve health outcomes. We established a number of unique programs that are financed through innovative strategies-including pharmaceutical investments, and other state partnerships. They focus on chronic diseases, the area that accounts for one of the largest portions of Medicaid spending. We spend 50 percent of our Medicaid budget on 5 percent of our beneficiaries. In 1997, Florida Medicaid was one of the first state Medicaid programs to establish a disease management program, and may, today, have the largest Medicaid initiative in the U.S. We have learned a great deal about what works and what does not. Time is needed to realize the full benefits of disease management, but early outcomes are positive and worth noting. This is what we know¾disease management works. It saves dollars. For a three-year period starting in July 2000, it is estimated that through program savings and manufacturer guarantees, federal and state Medicaid program spending has been reduced by nearly $90 million. And, more importantly it has led to changes in health behaviors, better health outcomes, and improved quality of care and life. We have seen individuals lose weight, start exercising, and check their blood pressure and blood sugar on a daily basis. Many have returned to more active lifestyles, allowing some to return to work. In Florida, we started with a demonstration project and have now implemented disease management programs for asthma, autoimmune disorders, congestive heart failure, diabetes, hemophilia, HIV/AIDS, hypertension, and depression. Our goals have been to educate consumers, promote best practices, improve health outcomes and care coordination, and reduce both emergency room visits and inpatient hospitalizations. Our first efforts were segmented. That is, we assigned beneficiaries to specific interventions targeted for specific diseases. We quickly found that significant numbers of beneficiaries had more than one chronic condition. This led us to change the program to address patients with multiple diseases. We adjusted our focus to caring for the total patient, not just the diseases. Disease Management Programs Beneficiary education and consultation has been a primary focus of the GlaxoSmithKline program as they have provided funding through a medication error demonstration project. AstraZeneca has funded outreach to physicians through regional pharmacists. The first effort to serve patients with multiple diseases was through our partnership with Pfizer, Inc., to serve people with asthma, congestive heart failure, diabetes, and hypertension. Pfizer provided a grant for disease management services, and the Agency contracted with 10 high-volume hospital systems and one call center. Patients are matched with 60 nurse care mangers to provide one-on-one beneficiary education and to support change in health behavior. The program expanded-doubling from the original 50,000 targeted population-to more than 113,000 beneficiaries enrolled in this disease management program. Participants work individually with their nurse care managers who assess their physical, mental and environmental status, provide education about their diseases, support healthy behavior changes, coordinate care with primary care providers and specialists, and help with access to other needed services. The process empowers people. It helps them make better health care choices and navigate the health care system more efficiently. It provides help with managing the conditions at home by offering glucometers and lancets for diabetics, pillow covers and peak flow meters for asthmatics and weight scales and blood pressure cuffs for heart failure patients at no charge to either the beneficiary or Medicaid. With Bristol-Myers Squibb we launched a second partnership to provide disease management services through a contract with Federally Qualified Health Centers in seven counties. For the first time we employed a faith based outreach model using Promotoras (lay health workers) with health professionals, and social workers to provide education and support for a minority population with diabetes and depression. More than 2,100 minority beneficiaries have been enrolled. These partnerships offer a new funding model financed by pharmaceutical manufacturers through a combination of investments and guaranteed savings. Service delivery is focused in the communities where beneficiaries live and requires daily involvement by participants toward a goal of improving both their overall health and their quality of life. Let me provide an example. Cora Stewart is a 62-year-old Miami woman with diabetes, hypertension, congestive heart failure and emphysema. Before enrolling in disease management under the Pfizer grant, she was insulin dependent, had high cholesterol and could not walk a block or climb stairs. Working with her nurse care manager, Cora lost 45 pounds in six months. She began monitoring her blood pressure at home. She recently attended her daughter's wedding - without the walker she has relied on for years. She has taken control of illnesses that previously controlled her life. These disease management programs have reduced inpatient hospitalizations and the number of emergency room visits, brought a new level of coordination to every participant's total health care, and improved their quality of life immeasurably. And as if those outcomes were not enough, we have realized substantial cost savings. Disease management is a powerful tool both in managing health and in containing Medicaid costs. This common sense approach is emerging as the next important chapter in health care. Thank you. I will be happy to answer any questions you may have. Disease Management Initiative
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