Medicaid populations can benefit from DM interventions
As the spiraling cost of healthcare continues to strain federal and state budgets, state Medicaid agencies are looking for powerful, workable solutions to the crisis.
As the spiraling cost of healthcare continues to strain federal and state budgets, state Medicaid agencies are looking for powerful, workable solutions to the crisis. Alternatives are needed that do not reduce benefits or tighten eligibility requirements for a population that largely relies on Medicaid as its only source of healthcare coverage.
A successful disease management (DM) program can help stem the rising tide of medical costs. The primary mission of DM is to help individuals with chronic illness reach optimal health while reducing medical costs. By supporting the patient-physician relationship and educating individuals on how to take more responsibility for their health, DM can help prevent costly hospitalizations and emergency department visits.
SUNSHINE STATE'S DM EFFORTS LifeMasters and Florida's Agency for Health Care Administration (AHCA) have worked together since September 2000 in one of the industry's first public-private collaborations, providing Medicaid beneficiaries in northern Florida with DM services for congestive heart failure and all related conditions and comorbidities, including diabetes, COPD, hypertension and depression.
Despite this higher cost, Medicaid DM programs will still generate a positive return on investment (ROI) because of the higher level of program acceptance and adherence by beneficiaries and their physicians, and the lack of other coordination-of-care efforts directed toward the population.
The LifeMasters/AHCA DM program works and proves that DM can take on the multilayered challenges of access, quality, cost, and care coordination with low-income population-and reap millions of dollars of savings in the process. As a result, LifeMasters and AHCA were honored with the 2004 AstraZeneca-National Managed Health Care Congress Partnership Award, which recognizes organizations that demonstrate quality, access, and efficiency of healthcare delivery through the cooperation and collaboration of organizations.
This section is underwritten by an unrestricted editorial grant from NMHCC.
Conversations With Perry and Friends
April 14th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. His guest this episode is John Baackes, the former CEO of L.A. Care Health Plan.
Listen
Breaking Down Health Plans, HSAs, AI With Paul Fronstin of EBRI
November 19th 2024Featured in this latest episode of Tuning In to the C-Suite podcast is Paul Fronstin, director of health benefits research at EBRI, who shed light on the evolving landscape of health benefits with editors of Managed Healthcare Executive.
Listen
Why Better Data and Awareness Matters for Medicaid Work Requirements
April 17th 2025With policymakers considering work requirements for Medicaid eligibility, Jennifer Haley, principal research associate in the Health Policy Division at the Urban Institute, said it’s more important than ever to understand how those changes could unintentionally cause harm, particularly when data systems fall short and public awareness is limited.
Read More
