Applying disease management strategies to Medicare

Medicare coverage begins for many when they have already developed one or m ore chronic diseases, and it often pays for the latest and costliest phases . Population-based disease modeling, patient screening, and monitoring woul d be appropriate interventions for chronic renal disease. Patients who have not get advanced to end-stage renal disease would benefit from management of diabetes and hypertension, avoidance of nephrotoxic substances, and bett er preparation for dialysis. Administrative support could take the form of clinical guidelines, physician-led multidisciplinary teams, integrated deli very systems, provider and patient education, and new information technolog ies. Medicare reflects the long-term public perspective, and thus should fu rther this new direction by supporting education, reimbursing for preventio n efforts and allied health services, encouraging efficiency, and monitorin g cost and quality outcomes.