Disease Management Initiative
The Agency for Health Care Administration has contracted with disease management organizations to provide disease management services to Medicaid recipients enrolled in the Primary Care Case Management Program (MediPass) who have been diagnosed with diabetes, HIV/AIDS, asthma, or hemophilia. The Agency is currently in contract negotiations to provide disease management services for MediPass recipients with congestive heart failure and end stage renal disease, and anticipates services for those disease states to begin in the third quarter of 2000. Disease management services may also be implemented for MediPass recipients who have been diagnosed with sickle cell anemia, cancer, or hypertension.

Who is Eligible?
The Medicaid disease management projects are available only to Medicaid recipients enrolled in MediPass. The MediPass population represents over 560,000 of the more than 1.5 million Florida Medicaid recipients. The Agency has determined that 16 percent of the MediPass population meets the criteria for the four disease states the Agency currently manages. All MediPass recipients meeting the criteria for participation in a disease management program are automatically enrolled in the disease management initiative, but can disenroll at any time.

Why Disease Management?
Results of disease management studies conducted around the country indicate that closely managing patients with chronic diseases can reduce the higher cost services these patients often require and at the same time improve quality of life for the patient. Disease management also can prevent or delay the onset of the more severe stages of a disease.

Design and Objectives
In 1997, the Florida Legislature authorized disease management and directed the Agency to "select methods for implementing the program that included best practices, prevention strategies, clinical-practice improvement, clinical interventions and protocols, outcomes research, information technology, and other tools." The Florida disease management initiative has been designed to promote and measure: health outcomes, improved care, reduced inpatient hospitalization, reduced emergency room visits, reduced costs, and better educated providers and patients. It is also expected that the disease management initiative will bring an enhanced connection between the patient and the provider, making a significant impact on health outcomes and improved quality of life for patients with chronic diseases.

Provider Involvement
The Agency identifies potential MediPass disease management recipients through paid claims. Prospective recipients are notified by the Agency and the disease management organization that they are eligible for participation in the program and are advised of the additional care management benefits that are a part of the disease management initiative. The Agency also notifies the MediPass primary care physicians of those recipients in their MediPass patient caseloads who meet the criteria for disease management services. Providers may refer their MediPass patients who are not already enrolled and who may benefit from a program. The disease management care managers become an extension of the physician’s services by helping the enrolled patients better understand their diseases and make necessary life style changes with the goal of self-management. Providers are informed of their enrolled patients' progress through ongoing reports. In addition, providers are provided with clinical practice guidelines developed by leading experts in the treatment of each disease state.

The Future
The Agency encourages MediPass physicians and entities to work closely with the disease management organizations to make this concept a successful effort. This program should prove to be beneficial to both the patient, the provider, and Medicaid. The disease management initiative is expected to ultimately improve the health and well being of MediPass patients, provide additional resources to MediPass providers, and reduce costs associated with patients who have a chronic disease.