April 2004

Disease Management Options: Issues for State Medicaid Programs to Consider

As states consider options for incorporating disease management programs into Medicaid, they can benefit from Medicare's prior experience in this area. This brief summarizes Mathematica's study of best practices in care coordination for people with chronic illnesses. The research was launched to study possible reforms and innovations to Medicare's fee-for-service system, as a result of a congressional mandate in the Balanced Budget Act of 1997. Researchers examined over 300 programs developed by a wide range of organizations including managed care plans, commercial firms, and academic medical centers that aim to improve quality of care and reduce costs by coordinating care for chronically ill people. This brief draws on that study to suggest key factors for states to consider as they move forward to develop disease management programs incorporating care coordination in Medicaid.