Older adults and persons living with disabilities make up the bulk of the Medicare beneficiary population. They are also among the nation’s most vulnerable and costly populations affected by chronic disease. MA Plans are seeking opportunities to enhance preventive and wellness services to improve the management of their members’ chronic conditions. Studies have shown that personal behavior impacts health outcomes by 30-40%. It is important to offer evidence-based chronic disease self-management programs that increase member awareness, support self-management activation and build skills that address healthy diet, smoking, and physical activity.
Chronic Disease Self-Management Education (CDSME) and specific falls prevention programs are evidence-based. They have been shown to engage and motivate health care consumers so that they are more involved in their care, increase their confidence (also known as self-efficacy) for symptom and health care management, and improve many measures related to health status, health care, and costs. CDSME programs are well suited to help improve the status of high-risk members because they are peer-led, provide a supportive environment to facilitate change, and empower participants to take charge of their health.
To qualify as a MA Plan, private plans and insurers must meet stringent Medicare guidelines and they must demonstrate their ability to achieve adequate Medicare star rating quality and performance metrics.
For example, there are specific prevention measures that targeted health plan members living with diabetes must meet each year. Additionally, some star ratings measures address falls and falls prevention best practices. Self-management programs can help to motivate members to address their diabetes and to complete fall prevention screenings in a timely manner. The delivery of self-management programs in concert with other MA Plan quality improvement initiatives can enhance quality scores for the MA Plans.
In addition, MA Plan members are surveyed annually. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is administered by independent organizations approved by CMS. Those CAHPS measures most likely to be impacted by CDSME programs include:
- Provider support for managing chronic conditions;
- Provider/consumer communication;
- Health promotion and education;
- Falls prevention and post falls assessment/referral;
- Health status and functioning; and
- Help taking prescribed medications
