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Care Improvement Plus

Chronic Care Management Facts

What is Chronic Care Management?
Chronic care management is an approach to improving health care for people living with chronic illnesses such as diabetes and heart failure. Effective programs help patients avoid complications and hospitalizations by providing them with disease management services, education, tools and resources that encourage them to take an active role in managing their health. Programs also support physicians by providing resources and expertise to help them care for their chronically ill patients.

The Magnitude of Chronic Illness
  • More than 133 million Americans live with chronic illnesses. 1
  • Chronic diseases such as diabetes and heart failure are the leading cause of death and disability in the U.S.,accounting for 70 percent of all deaths.1, 2
  • Nearly 80 percent of Medicare beneficiaries have at least one of the following chronic conditions: stroke, diabetes, emphysema, heart disease, hypertension, arthritis, osteoporosis, Parkinson's disease or urinary incontinence.2
  • People with chronic conditions are the most frequent users of health care in the U.S. They account for 81 percent of hospital admissions; 91 percent of all prescriptions filled; and 76 percent of all physician visits4
  • About one-fourth of people with chronic conditions have one or more more daily activity limitations5
The Cost of Chronic Illness
  • The medical care costs of people with chronic diseases account for more than 75 percent of the nation's $2 trillion medical care costs.1
  • The costliest five percent of Medicare beneficiaries account for about half of all Medicare spending each year. Among this top five percent, 47 percent had congestive heart failure and 35 percent had diabetes.6
  • Cardiovascular Disease was estimated to cost the nation $475.3 billion in 2009 in health expenditures and lost productivity6
  • People with chronic conditions are the most frequent users of health care in the U.S. They account for 81% of hospital admissions; 91 percent of all prescriptions filled; and 76 percent of all physician visits4
  • About one-fourth of people with chronic conditions have one more more daily activity limitations5
  • The estimated cost of diabetes in 2007 was $174.8 billion. Of this amount, 116 billion was due to direct medical costs and 58 billion to lost productivity.8

The Power of Disease Management
Care Improvement Plus' care management program is based on a disease management model XLHealth has successfully implemented for Medicare Advantage health plan clients over its twelve year history.

Over a two year period, XLHealth realized notable improvements in significant clinical outcomes for approximately 12,000 Medicare Advantage plan members with diabetes and/or heart failure, including:

  • A 21 percent reduction in the number of inpatient hospital admissions
  • A 25 percent decrease in the number of participants with "poorly controlled" blood sugar levels
  • A 19 percent decrease in the number of participants with poor control of their LDL (bad) cholesterol levels

In addition, the program increased adherence to recommended best practices aimed at reducing participants' risk of developing complications, including:

  • A 25 percent increase in the number of participants taking an ACE Inhibitor medication to reduce their risk of cardiovascular complications
  • A 20 percent increase in the number of participants taking a Beta Blocker medication to reduce their risk of cardiovascular complications

SOURCES:



This page was last updated on: 8/23/2011 11:18:55 AM
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Care Improvement Plus is a Medicare Advantage organization with a Medicare contract. The Care Improvement Plus contract with CMS is renewed annually and coverage availability beyond the end of the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information contact the plan. To be eligible for a Care Improvement Plus plan you must be a Medicare beneficiary living in Arkansas, Georgia, Missouri, South Carolina, Texas and select counties in Illinois, Iowa, Indiana, Maryland, New Mexico, New York, Wisconsin and have both Medicare Part A and Part B to enroll.

To be eligible for a Care Improvement Plus Chronic Conditions Special Needs Plan, you must have diabetes and/or heart failure. To be eligible for Care Improvement Plus Dual Advantage, you must be enrolled in state Medicaid and be a dual eligible beneficiary whom the State holds harmless for Part A and Part B cost sharing.

Members may enroll in the plan only during specific times of the year. Contact Care Improvement Plus for more information. If you have diabetes, heart failure, or Medicaid/Low Income Subsidy, you may qualify to enroll in a Care Improvement Plus Special Needs Plan ANYTIME of the year by exercising a “Special Election Period.

You must continue to pay your Medicare Part B premium. If you are a full benefit dual beneficiary and your Part B premium is paid for by the State, you will not be responsible for paying your Part B premium. Premiums, copays, coinsurance and deductibles may vary based on the level of help received. Limitations, copayments and restrictions may apply.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1–800–MEDICARE (1–800–633–4227). TTY users should call 1–877–486–2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1–800–772–1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1–800–325–0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for extra help to pay their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at 1–800–772–1213.TTY users should call 1–800–325–0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp. If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a part of this premium, we will bill you for the amount that Medicare doesn’t cover.

Premiums, copays, coinsurance, and deductibles may vary based on the level of help that beneficiaries may receive. Contact the plan for further details. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under nonroutine circumstances, and quantity and restrictions may apply. It may cost more to get care from out–of–network providers, except in an emergency. If there isn’t a network provider available for you to see, you can go to an out–of–network provider but still pay the in–network amounts except for members who live in our Maryland service areas. Those members can only use doctors, specialists, or hospitals in–network. The health providers in our network can change at any time.