"Chronic conditions, such as diabetes and heart disease, are a leading cause of illness and death among Medicare beneficiaries," said Barbara Hoffman, director of the Division of Chronic Care Improvement Programs at the Centers for Medicare & Medicaid Services. "This program will help us improve the quality of health care for the growing population of beneficiaries with chronic illness."

"Green Ribbon Health's mission is to provide community-based services that support people's individual choices about their health and that respect their personal and cultural values," added Jean Bisio, chief executive officer of Green Ribbon Health.  "Our goal is to work together with participants and their caregivers, doctors, hospitals, and other community organizations to provide comprehensive, holistic and realistic solutions to very complex health and psycho-social concerns."

"The first people joining the program are already seeing the benefits of participating," said Bisio.  "We have a grandmother who, in addition to dealing with the complexity of diabetes, is taking care of family members and in her own generosity will go without basic necessities like food and clothing.  We want to make sure she has what she needs to live on a daily basis in addition to understanding her diabetes.  We also have a gentleman who has congestive heart failure and diabetes but wasn't using his new glucometer because he didn't know how.  Simple things like helping people understand how to use their tools can be critical to maintaining health. This is the kind of support this program offers."

Chronic conditions are a leading cause of illness, disability, and death among Medicare beneficiaries and account for a disproportionate share of health care expenditures.  For example, about 14 percent of Medicare beneficiaries have congestive heart failure, but account for 43 percent of Medicare spending.  About 18 percent of Medicare beneficiaries have diabetes, accounting for 32 percent of Medicare spending.

The pilot programs in the first phase will reach approximately 180,000 beneficiaries who are enrolled in traditional fee-for-service Medicare and who have multiple chronic health conditions including congestive heart failure or complex diabetes. Beneficiary participation will be voluntary and will not affect people's access to services or their ability to choose their doctors and other health care providers.  Their Medicare benefits will not change as a result of receiving these additional health support services. The programs will be available at no charge to participants.

Programs will offer self-care guidance and support to chronically ill beneficiaries to help them manage their health, adhere to their physicians' plans of care, and ensure that they seek and obtain Medicare-covered benefits that will help reduce their health risks. The specific types of quality improvement and cost reduction strategies to help beneficiaries with chronic illnesses include:

• 24/7 access to registered nurses to help people cope with their health concerns
• Connection with a multi-disciplinary team of care managers, social workers and peer counselors to conduct home visits, group classes, coordination with providers, and referral to community resources
• Personal Nurses available to provide medication management, depression screening, nutritional counseling, laboratory monitoring and health support on an individualized basis.
• Use of technology to enhance participant follow-up, communication and coordination of care

More than 35 national organizations, including AARP, the American Heart Association, and the American Diabetes Association among many others, are helping CMS promote awareness and understanding of the Medicare Health Support pilot program.