The 1997 Florida Legislature directed the Agency for Health Care Administration to implement a disease management initiative to improve health outcomes and reduce taxpayer costs for Medicaid clients with asthma, diabetes, HIV/AIDS, and hemophilia. Legislation passed in 1998 expanded the initiative to include Medicaid clients with hypertension, cancer, end-stage renal disease, congestive heart failure, and sickle cell anemia.
The still incomplete initiative cost the state $24.1 million through February 2001. The agency has not determined whether the initiative improved health outcomes and saved the $112.7 million projected over four years. In February 2001, the agency backed off making a vendor repay $7.6 million because the agency did not establish an explicit method to measure cost savings before contracting for disease management services.In general, the agency failed to address significant problems that impeded the initiative. Further, the initiative design does not adequately address problems of the chronically ill who often suffer from multiple diseases. In addition, the design is inefficient and fosters inconsistencies.We recommend that the Legislature direct the agency to