Medicare Program; Medicare Coordinated Care Demonstration Project and Request for Information on Potential Best Practices of Coordinated Care

I. Background

Section 4016 of the Balanced Budget Act of 1997 (Public Law 105-33) requires the Secretary of Health and Human Services (the Secretary) to evaluate best practices in the private sector for methods of coordinated care. The statute also directs the Secretary to design demonstration projects for the Medicare fee-for-service population based on the evaluation. The purpose of the demonstration is to evaluate models of coordinated care that improve the quality of services provided to specific beneficiaries who have a chronic illness and reduce expenditures under Parts A and B of the Medicare program. We competitively awarded a task order for conducting a review of best practices in coordinated care and for providing a recommendation of demonstration design options to Mathematica Policy Research, Inc. (MPR). We will perform the final assessment of best practices and select the demonstration design.

II. Provisions of This Notice

This notice announces our intent to conduct the Medicare Coordinated Care Demonstration and informs interested parties of the opportunity to submit information on potential best practices of coordinated care. In addition, this notice also requests comments on potential aspects of the overall demonstration. We are looking for information on successful models of coordinated care, disease management, or case management that are appropriate for the Medicare fee-for-service population. Information about, and evidence of, successful models can be found in published literature; however, published literature is likely to be a limited resource and successful programs may not have been documented. Therefore, we would like to give interested parties the opportunity to submit information about models of coordinated care that are known to have achieved measurable success but may not have been discussed in published literature. We anticipate this information will complement the review being conducted by MPR. Additional information regarding MPR's review can be found on their website (www.mathematica-mpr.com/projects/ bestpractices). Any person or organization may submit information about successful programs; however, the information must provide evidence of success in sufficient detail to be useful. Therefore, operators of programs may be in the best position to submit information regarding their approach. The following items of information should be submitted: • The name and address of the program. • The name, address, telephone number, facsimile number, and e-mail address of a contact person. • Background on the program (including goals, history, relationship to larger organization(s), number of clients served, and length of time the program has been in operation). • Special or innovative features of the program. • Size and composition of the staff (number of RNs and number of social workers performing case management).

• Referral sources, targeting criteria, and selection criteria, if any, for participants. • The patients served by the program (including age ranges, diagnoses or conditions, and functional impairments). • Program intervention and how services differ from the usual care the patient would have received. • How care plans are developed and monitored for each patient. • Patient education efforts, if any. • Patient monitoring efforts, if any. • Feedback to providers, if any. • Average length of time patient is in the program. • Funding source(s) for the program. • Financial incentives, if any, for providers and patients to participate. • Outcome measures by which the program's performance is evaluated (including clinical, utilization, client-reported, and financial measures used). • Program impacts on these measures. • Cost savings due to the program (total and per person served per month). • How program impacts and cost savings were calculated (for example, method of estimating reduction in use and costs, such as comparison to control group or prior year experience). • Costs of operating the program (average per patient per month costs). • Adaptability of the program to the Medicare fee-for- service setting. • Program brochures or published articles, if any. We are also interested in comments on potential aspects of the overall demonstration. Specifically, we are interested in comments that discuss and distinguish program characteristics known to be essential for positive outcomes in a fee-for-service setting. Commenters may also wish to address the types of providers, organizations, or entities capable of, and qualified to provide, coordinated care or case management services. Other aspects of importance include, but are not limited to: • The relationship of the case management entity with other providers. • The potential role of the case manager in authorizing or providing services beyond coordinating and educational activities. • Appropriate incentives for the case management entity, beneficiaries, and other providers. • Appropriate payment methodology. • Potential risk bearing arrangements for the case management entity. In addition, we seek comments regarding challenges to, and potential solutions for, implementing a coordinated care demonstration in rural sites. We currently envision evaluating the data using a multi-tiered review process that will focus on structure, process, and outcomes. Review of individual programs will include the following review criteria: • Programs that are currently functioning. • Programs that decrease health care costs or utilization without adversely affecting health outcomes or that improve health outcomes without increasing health care costs or utilization. • Programs that are suitable for the Medicare fee-for- service population. • Programs that are targeted to common diseases in the Medicare population. We will also examine a program's structural characteristics and specific features of its program interventions. Responders should submit written information or comments to the above address. We encourage the public to submit information or comments as soon as possible to permit the maximum amount of time for consideration. Written information or comments received by 5 p.m., June 21, 1999, will be considered in drafting the demonstration design recommendations. Given the timeline for establishing this demonstration, there will not be sufficient time to consider information or comments received after this deadline.

III. Collection of Information Requirements

Section II of this notice contains information collection requirements that were approved by the Office of Management and Budget under the Paperwork Reduction Act of 1995 on January 5, 1999. The approval number is 0938-0750 and the expiration date is June 30, 1999.

Authority: Section 4016 of the Balanced Budget Act of 1997 (Public Law 105-33).

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical Assistance Program; No. 93.773 Medicare--Hospital Insurance Program; and No. 93.774, Medicare--Supplementary Medical Insurance Program)

Dated: March 16, 1999. Nancy-Ann Min DeParle, Administrator, Health Care Financing Administration. [FR Doc. 99-7079 Filed 3-22-99; 8:45 am] BILLING CODE 4120-01-P