Overview

In June 2003, CMS approved the Indiana Office of Medicaid Policy and Planning's proposal to create the Indiana Chronic Disease Management Program (ICDM), to provide enhanced Medicaid benefits to state residents with diabetes, chronic heart failure, and asthma. The program, a joint initiative between the state's Medicaid agency and the Department of Health, has been rolled out in phases. As of October 2004, the disease management was operating statewide for diabetes, pediatric asthma, and congestive heart failure, and the hypertension and stroke components were being implemented. It is expected to help 26,000 beneficiaries, both adults and children, and is particularly targeted to enrollees whose health care costs place them in the top 10 percent of program expenditures.

Once enrolled in ICDM, individuals work with a nurse case manager to develop a treatment plan to maximize control of this disease. High-risk enrollees receive intensive, one-on-one nurse care management through a network that includes the Indiana Minority Health Coalition and the Indiana Primary Health Care Association. Those with less intensive conditions work by telephone with their case manager. The state has contracted with AmeriChoice to run a centralized telephone call center that accepts calls from enrollees and makes proactive calls to conduct medical assessments and provide education, dietary information, and instructions on how to manage their care. The program is expected not only to save money for the state's Medicaid program, but to increase the quality of life for enrollees.

To gauge the program's success in improving health and saving money, the state consulted Regenstrief Institute, a nonprofit health care research organization affiliated with the Indiana University School of Medicine. Regenstrief helped the state design a randomized controlled trial, the first of its kind among Medicaid disease management programs. The trial compared two groups of Medicaid members eligible for ICDM; one group received the intervention and the other did not. From September 2003 to May 2005, the researchers examined patient behavior, hospitalization rates, drug utilization, and member satisfaction, in addition to cost and quality indicators. It revealed that most significant results were found in the population with congestive heart failure. For this control group, costs were reduced by over $720 per member per month. When projected to the entire program, the findings indicate the program could generate a savings as great as $29 million.

For More Information

Web site: www.indianacdmprogram.com