Oncology Care Included in Medicare Disease Management Demonstrations

June 1, 2002

Oncology care will be the focus of one of the new Medicare disease management demonstration programs soon to be initiated. Medicare remains convinced that disease management services can provide substantial savings. There is, however, a problem: Fee-for-service Medicare, which includes most recipients, does not allow for disease management, except in one or two instances, such as diabetes self-education. The Medicare+Choice program-comprised mostly of health maintenance organizations-offers disease management, but seniors have, for the most part, avoided this plan. Therefore, Medicare has selected 15 sites for case management and disease management services, which will be offered to Medicare fee-for-service beneficiaries with complex chronic conditions. Quality Oncology, Inc, of McLean, Va, will implement an urban disease management program targeting beneficiaries in Broward County, Fla.

Oncology care will be the focus of one of the newMedicare disease management demonstration programs soon to be initiated.Medicare remains convinced that disease management services can provide substantialsavings. There is, however, a problem: Fee-for-service Medicare,which includes most recipients, does not allow for disease management, except inone or two instances, such as diabetes self-education. The Medicare+Choiceprogram—comprised mostly of health maintenance organizations—offers diseasemanagement, but seniors have, for the most part, avoided this plan. Therefore,Medicare has selected 15 sites for case management and disease managementservices, which will be offered to Medicare fee-for-service beneficiaries withcomplex chronic conditions. Quality Oncology, Inc, of McLean, Va, will implementan urban disease management program targeting beneficiaries in Broward County,Fla. 

The idea is for Quality Oncology to match the plan of care written by thepatient’s own oncologist. The Quality program’s medical director willcontact the patient’s oncologist to discuss any differences between the careplan and the guidelines. A care manager will provide patient education andcounseling, care coordination, and service arrangement.