Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Indiana's Chronic Disease Management Program

http://wwwdes individualized nurse care management and services through a centralized call center to Medicaid beneficiaries with diabetes, congestive heart failure, and chronic kidney disease. The program is intended to improve health outcomes and it is now also showing evidence of financial savings. Jeanne LaBrecque, Indiana's director of Medicaid and Health Policy, explains: "The program empowers patients to take better control of their health care. As a result, we have seen decreases in hospitalizations, fewer expensive crises, and a potential for further cost savings overall."

ICDMP identifies Medicaid enrollees with a high predicted future cost based on their chronic condition. The highest-risk individuals work with a nurse care manager to develop treatment plans to maximize personal control of their disease. These members receive intensive, one-on-one nurse care management. The care managers meet with members, educate them about their condition, and assist them in setting goals to improve their health. The nurse care managers occasionally accompany a member to physician appointments in an effort to strengthen the relationship between members and their doctors.

Members with less complex cases are referred to the ICDMP Call Center, where care coordinators call members to discuss medications, nutrition, and exercise and make a health assessment. Members also receive educational materials by mail.

Since being launched in 2003, ICDMP has provided services to more than 50,000 Indiana residents. The program currently has 15 nurse care managers working with clients across the state.

The Indiana Family and Social Services Administration and State Department of Health jointly run ICDMP. The Department of Health and ICDMP have adopted Indiana Consensus Guidelines on care for congestive heart failure, diabetes, and asthma and made them available to every doctor in the state. While the program targets Medicaid enrollees, Medicaid providers can use the protocols and guidelines for any patient with a chronic condition. Each year in Indiana, more than 41,000 people die due to chronic diseases. Medicaid also provides a free, Web-based chronic disease registry to help providers track patients and proactively address their needs.

The state contracted with the Regenstrief Institute, a nonprofit health care research organization affiliated with the Indiana University School of Medicine, to determine the impact of ICDMP on health and costs over the September 2003 to May 2005 period. Using a randomized controlled trial, the first of its kind among Medicaid disease management programs, the Institute, in their preliminary analysis, has found substantial cost savings in the congestive heart failure group and minimal cost savings to the state for diabetes. Costs were reduced for the CHF enrollees by more than $700 per member per month, which would yield savings as high as $29 million if projected to the state's entire Medicaid program. Regenstrief Institute is conducting further analysis on the program and preparing future papers for publication.

For More Information
Contact: Katie Holeman Shipp, Indiana Chronic Disease Management Program,
Indiana Family and Social Services Administration, (317) 234-3804

Publication Details