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.

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

Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.