In 2008, Barack Obama promised to reform health care.
One of his many health care promises included a pledge to require health insurers to use disease management programs to lower costs. Health plans in a new "public plan,” in Medicare or in the Federal Employee Health Benefits program would all have to participate, he said.
"Disease management” covers a wide range of programs to help people with chronic diseases better coordinate their health care. HealthReformGPS, a project of George Washington University, has an excellent primer.
It turns out that the president's 2010 health care law, the Affordable Care Act, includes a range of provisions to encourage disease management.
But are those programs now a required part of plans in health exchanges, in federal employee plans and in Medicare?
(Since Obama's public option never materialized, we're looking at requirements for private plans offered on new health care exchanges that launch in 2014.)
Here's what we found:
Health exchanges: Yes. The Affordable Care Act requires plans to cover a set of "essential benefits.” While some details will be set by states, the law requires that those benefits include "preventive and wellness services and chronic disease management.” So, except for grandfathered plans, which aren't yet required to offer essential benefits, some disease management services are required.
Medicare: Yes. Medicare and Medicare Advantage plans cover some disease management services, such as behavioral therapy for patients with cardiovascular disease and obesity, according to the Centers for Medicare & Medicaid Services. In addition, the health care law created the Center for Medicare and Medicaid Innovation to test new ways to improve care and save money, which may widen use of disease management programs. The models it's testing "strongly emphasize management of the chronically ill,” according to HealthReformGPS. (However, we should note that evidence so far shows that few disease management programs offer the expected Medicare savings, according to a paper published by Kaiser Family Foundation.)
Federal Employee Health Benefits: No. The government's latest requirements for health plans offered to federal employees say they "expect” insurers to offer programs "that promote health and wellness and which are aimed at improving employee productivity, enhancing healthy lifestyles, and lowering long-term health care costs.” That includes incentives for employees who adhere to disease management programs. But the guidelines stop short of requiring health plans to offer such programs.
In 2008, Obama promised to require that health plans use disease management programs to improve efficiency and lower costs. While his health care law includes a variety of provisions to support and expand disease management, such programs aren't yet required for federal employee health plans. Nor are they proving as effective at lowering Medicare costs as once hoped. We rate this promise a Compromise.