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Montefiore Begins Test to Show Benefits of Care Guidance for Pre-Selected Medicare Recipients in the

Montefiore One of Only Six Organizations Nationwide
Chosen by Centers for Medicare and Medicaid Services

MMC's Care Management Company to Lead Project Managing Chronic Illness

New York City, NY (June 13, 2006) — A US government project designed to demonstrate how professional coordination of healthcare services can improve the quality of life for Medicare recipients is now underway at Montefiore Medical Center. 

Montefiore, the largest healthcare provider in the Bronx, is one of only six healthcare providers in the US chosen by the Federal Centers for Medicare and Medicaid Services (CMS) to manage the three-year demonstration program designed to show how care coordination, assistance with social support and monitoring of patients' medical conditions can help prevent complications from illness and also lower healthcare costs by reducing emergency room visits and avoidable hospitalizations.

The Care Guidance Program is now actively enrolling pre-identified Medicare beneficiaries who live in 16 designated zip codes in the Bronx, all of whom have been identified by CMS as candidates for the special program.

"We believe that medical centers such as Montefiore must lead the industry in developing models for successfully managing chronic illness," said Spencer Foreman, MD, president of Montefiore. 

"We are invested in and committed to improving the quality of care for our patients and also to managing the expense associated with chronic illness," he said.  "This demonstration project provides us with the opportunity to use what we believe to be our unique competencies in this arena."

The Care Guidance Program will provide a number of services customized to meet the needs of individual participants.  Services will be coordinated by a Care Manager and will include such things as assisting with access to services, managing the intricacies of diseases and sometimes confusing medication regimens, how to maintain adequate nutrition and understanding the importance of designating a healthcare proxy and completing advance directives.  

"We hope to learn what works and what doesn't and help build a model for chronic care that is financially viable, sustainable and replicable," said Stephen Rosenthal, president and chief operating officer of CMO, the Care Management Company of Montefiore Medical Center.

CMS has a number of planned and ongoing care coordination and disease management demonstrations and programs.  Montefiore's Care Guidance Program is part of the Care Management for High Cost Beneficiaries (CMHCB) demonstration project, which is the first to focus specifically on provider-directed models of care for high-cost, fee-for-service Medicare beneficiaries. The program is not a managed care program.  Participation is voluntary and does not change the amount, duration or scope of an individual's Original Medicare benefits. All participants remain in the traditional fee-for-service Medicare program and incur no additional out-of-pocket costs for program participation. There is no restriction on beneficiary access to care (for example, there is no utilization review or gatekeeper function), or restriction to a limited provider network.  Providers caring for participants in the Care Guidance Program continue to bill Medicare on a fee-for-service basis.

The program is planned to run for three years.  During this time, the Care Guidance program will receive a monthly fee for each participant, to cover administrative and care management costs.  As a condition of participation in the demonstration, the Care Guidance program is at financial risk if savings targets are not met.