Chronic Care Improvement300
The Secretary shall establish programs for the improvement of chronic care, which shall be designed to improve clinical quality and beneficiary satisfaction for targeted enrollees with one or more “threshold conditions.”301 The developmental phase of these programs (Phase 1), will involve the development, testing and evaluation of chronic care improvement programs in select geographic areas by chronic care improvement organizations.302 The Secretary will contract for independent evaluations by a contractor with knowledge of chronic care management programs to assess specific program factors, including quality improvement measures, beneficiary and provider satisfaction and health outcomes.303 The implementation phase (Phase 2) involves program expansion to additional geographic areas, which is conditioned upon the program improving the clinical quality of care and beneficiary satisfaction.304 Each program will have a process to screen targeted beneficiaries for conditions other than threshold conditions in order to develop an individualized, goal-oriented care management plan,305 which will be provided to each participating beneficiary.306 This care management plan will include self-care education for the beneficiary307 and the use of monitoring technologies that enable patient guidance through the exchange of pertinent clinical information.308 In carrying out the care management plan, the organization operating the care improvement program will guide the participant in managing his health and in performing activities specified under the elements of his care management plan309 and will develop a clinical information database to track and monitor each participant across settings and to evaluate outcomes.310 The organization will monitor and report to the Secretary on health care quality, cost and outcomes.311
Footnotes
- 300. Social Security Act § 1807, 42 U.S.C. 1395b-8.
- 301. Social Security Act § 1807(a)(1), 42 U.S.C. 1395b-8(a)(1).
- 302. Social Security Act § 1807(b)(1), 42 U.S.C. 1395b-8(b)(1).
- 303. Social Security Act § 1807(b)(5), 42 U.S.C. 1395b-8(b)(5).
- 304. Social Security Act § 1807(c)(2), 42 U.S.C. 1395b-8(c)(2).
- 305. Social Security Act § 1807(e)(1)(A), 42 U.S.C. 1395b-8(e)(1)(A).
- 306. Social Security Act § 1807(e)(1)(B), 42 U.S.C. 1395b-8(e)(1)(B).
- 307. Social Security Act § 1807(e)(2)(B), 42 U.S.C. 1395b-8(e)(2)(B).
- 308. Social Security Act § 1807(e)(2)(D), 42 U.S.C. 1395b-8(e)(2)(D).
- 309. Social Security Act § 1807(e)(3)(A), 42 U.S.C. 1395b-8(e)(3)(A).
- 310. Social Security Act § 1807(e)(3)(C), 42 U.S.C. 1395b-8(e)(3)(C).
- 311. Social Security Act § 1807(e)(4)(A), 42 U.S.C. 1395b-8(e)(4)(A).
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