Montefiore News Releases
News ReleasesMontefiore Selected for Medicare Demonstration Project
Medical Center One of Six in Nation and Only One in NYC To Receive Federal Care Management Award
NEW YORK, NY - August 24, 2005 - Montefiore Medical Center has been selected by the Centers for Medicare and Medicaid Services (CMS) to operate a three-year demonstration project to help Medicare beneficiaries who have complex medical needs improve their quality of life and prevent complications of their illnesses. Montefiore is one of six organizations nationwide selected to participate in the Care Management for High Cost Beneficiaries (CMHCB) Project.
The goal of CMHCB is to provide better health outcomes while reducing the beneficiaries' medical expenses. Montefiore is an integrated healthcare delivery system serving a diverse population in New York, and under the demonstration project will provide a number of care coordination services as part of its "care guidance" program to selected Medicare beneficiaries who live in the Bronx through its care management company, CMO. Enrollment will begin early in 2006.
"We believe that 'care guidance' is a way to help high-risk Medicare patients better manage their complex medical conditions, and to assist in coordinating care delivery so beneficiaries receive the right healthcare services at the right time, and in a cost effective way," said Dr. Spencer Foreman, president of Montefiore Medical Center.
"Our goal is to increase the value of Medicare expenditures and to provide quality care to a population in need of effective, coordinated care management," said Stephen Rosenthal, president of CMO.
"This demonstration project will focus on Medicare beneficiaries who have the most to gain from our health care system, but who too often don't get the best possible prevention-oriented care," said CMS Administrator Mark B. McClellan, MD, PhD. "They often see numerous doctors without the continuity of care and support needed to enable the health professionals to work together effectively, and they are often unable to take advantage of evidence-based steps to prevent the complication of their diseases."
The Care Management for High Cost Beneficiaries (CMHCB) demonstration project will test the ability of direct-care provider models to coordinate care for high-cost/high-risk beneficiaries by providing them with clinical support beyond traditional settings, without restricting their access to the full array of benefits available under the traditional Medicare program.
CMS has a number of planned and ongoing care coordination and disease management demonstrations and programs. The CMHCB demonstration will be the first effort to focus specifically on provider-directed models of care for high-cost fee-for-service Medicare beneficiaries. The awardees will receive a monthly fee for each beneficiary participating in the program, to cover their administrative and care management costs. Organizations are required to assume a financial risk if they do not meet established performance standards for achieving savings to Medicare.
Awardees will provide a variety of models, including support programs for healthcare coordination, physician and nurse home visits, use of in-home monitoring devices, electronic medical records, self-care and caregiver support, education and outreach, tracking and reminding of individuals' preventive care needs, 24-hour nurse telephone lines, behavioral health care management, and transportation services. In addition, awardees will have the ability to customize interventions to meet individuals' personal needs.
The participation of beneficiaries in the program will be voluntary, and programs will be offered at no charge to the beneficiary.
Participation will not change the amount, duration or scope of the individuals' Medicare benefits, which will be covered, administered, and paid under the traditional FFS Medicare program. Organizations chosen for the demonstration will not be able to restrict beneficiary access to care (for example, there can be no utilization review or gatekeeper function), or restrict beneficiaries to a limited number of physicians in a network.
Montefiore Medical Center, The University Hospital and Academic Medical Center for the Albert Einstein College of Medicine, ranks among the top one percent of all US hospitals based on its investments in medical innovation and cutting-edge technology.
Montefiore invests more in order to enable compassionate, personalized care and the most positive outcomes for patients and their families in New York, the tri-state area and beyond.
The 1,062 bed medical center includes the Henry and Lucy Moses Division, the
Montefiore treats all major illnesses and has distinguished centers of excellence in cardiology and cardiac surgery, cancer care, tissue and organ transplantation, children's health, women's health, surgery and the surgical subspecialties. Montefiore Medical Center focuses on providing family-centered healthcare in a nurturing environment that extends well beyond hospital and clinic walls.
CMO, Montefiore's innovative care management subsidiary, provides clinical and healthcare financial services to a patient population of 179,000 health plan members, through a community-based healthcare delivery system that includes a network of 2,300 credentialed providers.
Working to improve the quality and continuity of patient care, CMO helps members with medical and behavioral case management, disease management, and health and wellness programs. In addition to care guidance, CMO provides full service claims administrative services. CMO is dedicated to improving the quality of life of its members, while lowering costs and reducing unnecessary hospitalizations.