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Office of Program Policy Analysis and Government Accountability

Progress Report: Medicaid Disease Management Initiative Has Not Yet Met Cost-Savings and Health Outcomes Expectations, Report No. 04-34, May 2004
 
Full report in PDF format


  • The 1997 Legislature directed the Agency for Health Care Administration to establish a Medicaid disease management initiative to help control expenditures and improve health outcomes for chronically ill Medicaid recipients.  However, after nearly seven years, the initiative continues to fall short of legislative expectations and intended goals.
  • The initiative does not provide disease management services for all of the chronic diseases specified by the Legislature.  Although the initiative has included disease management services for seven disease states, as of March 2004, services were available for only five of nine chronic diseases.  In addition, the initiative continues to serve only a small percentage of eligible recipients.
  • Due in part to this slow implementation, the Initiative has achieved only a small portion of the projected savings.  To date, the initiative has reportedly saved $13.4 million; however, the agency has not finalized cost savings for several programs.  In addition, cost savings are likely overstated because of weak approaches used to estimate baseline costs.  Further, the agency has not sufficiently assessed whether health outcomes of chronically ill Medicaid recipients have improved.  Finally, agency oversight does not ensure that recipients receive appropriate levels of services or that physicians support the initiative and use best practice guidelines.

What were our earlier findings?

Report No. 01-27  Justification Review: Medicaid Disease Management Initiative Sluggish, Cost Savings Not Determined, Design Changes Needed, published in May 2001.

Which Government Program Summaries contain related information?

Agency for Health Care Administration
Medicaid Health Care Services

What other OPPAGA-related materials are available?

  • Report No. 04-53 Progress Report: Medicaid Should Improve Cost Reduction Reporting and Monitoring of Health Processes and Outcomes, published in August 2004.
  • Report No. 03-27 Progress Report: Changes to Medicaid Preferred Drug List Requirements and Competitive Bidding Pharmacy Contracts Could Save an Additional $86.6 Million in 2003-04, published in April 2003.
  • Report No. 01-61 Justification Review: Expected Medicaid Savings Unrealized; Performance, Cost Information Not Timely for Legislative Purposes, published in November 2001.

Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
e-mail address: oppaga@oppaga.fl.gov


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