CMS ANNOUNCES AN ADDITIONAL SITE FOR DEMONSTRATION FOR BENEFICIARIES WITH END STAGE RENAL DISEASE
The Centers for Medicare and Medicaid Services (CMS) today announced that it has selected an additional organization, Evercare of Georgia, a United Healthcare product, to participate in a new demonstration that will increase the opportunity for Medicare beneficiaries with end stage renal disease (ESRD) to join managed care plans.
This demonstration has been designed to test the effectiveness of disease management models to increase quality of care for ESRD patients while ensuring that this care is provided more effectively and efficiently.
“Medicare is offering new, innovative health care options to chronically ill beneficiaries with ESRD,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “This demonstration can help us determine the benefits of disease management and care coordination for this population.”
Medicare Advantage organizations and dialysis providers are partnering to offer health plans to beneficiaries with ESRD. The health plans will provide all Medicare covered benefits with an emphasis on disease management and care coordination.
Evercare of Georgia will partner with DaVita, a dialysis provider to offer a Medicare Advantage Special Needs plan in DeKalb and Fulton counties in Georgia . Evercare will join two other demonstrations that were announced on October 31. The other demonstrations are SCAN Health Plan partnering with DaVita and Sterling Life Insurance Company/American Progressive Life and Health Insurance partnering with Fresenius Medical Care. For more information please see the CMS website: http://www.cms.hhs.gov/media/press/release.asp?Counter=1703
Beneficiaries will be able to enroll in these new plans beginning November 15, the Medicare health plan open enrollment period, with coverage beginning January 1, 2006.
An important aspect of this demonstration is the emphasis on quality improvement and pay-for-performance. CMS will reserve five percent of the capitation payment rates for incentive payments related to quality improvement. Participating organizations will receive payment for improvement on past performance and performing above the National averages for quality measures related to dialysis.
Participating organizations were selected through a competitive process. Organizations were selected based on technical review panel findings, organizational structure and operational feasibility.
Additional information on other Medicare demonstrations is available at http://www.cms.hhs.gov/researchers/demos/.