Date: July 5, 2005
CONTACT: Julie Toland, julie.toland@ttuhsc.edu

LUBBOCK – Texas Tech University Health Sciences Center today was announced as one of six organizations nationwide to operate a three-year demonstration project to help Medicare beneficiaries improve their quality of life while reducing their medical expenses and Medicare program costs.

“The pilot project will focus on Medicare beneficiaries who are considered ‘high cost’ and ‘high risk’ and will seek to improve their health through better quality care,” said Mark B. McClellan, M.D., Ph.D., administrator for the Centers for Medicare & Medicaid Services. “Beneficiaries with multiple progressive chronic conditions typically see numerous doctors without any one doctor knowing about or coordinating the care provided by the other doctors,” he said, noting that on average, these patients see seven different physicians and have 20 prescriptions each year.

Texas Senior Trails, a consortium of Texas Tech University Health Sciences Center, Texas Tech Physician Associates and TrailBlazer Health Enterprises LLC, will coordinate an integrated health care delivery pilot project for beneficiaries in 48 counties in the Texas Panhandle and South Plains area.

TrailBlazer Health Enterprises is the Texas Medicare fiscal intermediary and carrier. The company brings a successful 39-year history of working with the Medicare fee-for-service program, its beneficiaries and their providers. “TrailBlazer brings vast experience to the project and is an excellent partner in ensuring the success of the Texas Senior Trails Project,” said Lorri Velten, Texas Senior Trails Project administrator.

“We are proud to be able to have an opportunity to offer cost-effective quality care in a large group practice setting in the Lubbock and Amarillo demonstration site, as well as provide leadership for transforming cost-effective care at a national level,” said Richard V. Homan, M.D., dean of the School of Medicine.

The Care Management for High Cost Beneficiaries demonstration will be the first effort by the Centers for Medicare & Medicaid Services to focus specifically on provider-directed models of care for high-cost, fee-for-service Medicare beneficiaries. The Senior Trails Project will begin enrolling beneficiaries as early as January 2006.

The Texas Senior Trails Project will receive a monthly fee for each beneficiary participating in the program to cover their administrative and care management costs. Texas Senior Trails will employ a variety of models including health care coordination, physician and nurse home visits, use of in-home monitoring devices, self-care and caregiver support, tracking and reminders of individuals’ preventive care needs, behavioral health care management and transportation services.

The Texas Senior Trails Project on the Lubbock and Amarillo Health Sciences Center campuses will include collaboration with participants’ primary and specialist providers to enhance communication of relevant clinical information. The projects are intended to help increase adherence to evidence-based care, reduce unnecessary hospital stays and emergency room visits, and help participants avoid costly and debilitating complications. Beneficiaries eligible for participation in the demonstration will be identified by the Centers for Medicare & Medicaid Services and will have to meet eligibility criteria outlined by the Texas Senior Trails Project.

Beneficiary participation in the pilot projects will be voluntary and will not change the amount, duration or scope of participants’ fee-for-service Medicare benefits. Benefits will continue to be covered, administered and paid under the traditional Medicare program. Pilot project participation will be offered at no charge to the beneficiary. Organizations chosen for the demonstration, including Texas Senior Trails, will not be able to restrict beneficiary access to care or restrict beneficiaries to a limited number of physicians in a network.