Surprised

I had been anticipating this announcement as a defining moment for Medicare’s thrust into accountable care. My expectations had been that we would see either:

Boom — a big splash of new Medicare shared savings ACOs announced, including big name hospitals and medical groups that were starting large scale ACOs, perhaps with hundreds of thousands of patients.

Bust — no one showed up at the party. Providers would have concluded that Medicare ACOs were too risky, bureaucratic, and high effort.

Intrigued

What we got is something in the middle: (more…)

I am hearing that carriers are staying away from ACOs and are not planning on partnering.  What have you heard?

This is one of those blip-on-the-radar-screen comments that jarred my attention — and it raises very important questions about industry dynamics.

First, let me expand on the issue.  As I’ve written before, there are at least two broad categories of “accountable care initiatives”:

1) Formal Accountable Care Organizations (ACOs) by which care providers contract with Medicare

2) Informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans.

The list of accountable care animals in the forest is likely to keep growing. For example, just this week Oregon announced details for CCOs (Coordinated Care Organizations) for Medicaid.

So how are different stakeholders likely to react to the opportunity of a formal ACO contracting with commercial health plans? Let’s look at this from a couple of different angles.

(more…)

The health care market is moving toward accountable care. There are at least two broad paths forward:

1) Formal Accountable Care Organizations (ACOs) by which care providers contract with Medicare

2) Informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans

What are the differences between these routes? I see at least 5 factors at play:

• Transaction costs
• Timing
• Incrementalism
• Flexibility
• Capital cost

(more…)

Access to the full online article is currently available for free on the Center for Studying Health System Change website.

Key excerpts:

Conclusions. Health reform policies currently envisioned to improve care and lower costs may have small effects on high-cost patients who consume most resources. Instead, developing interventions tailored to improve care and lowering cost for specific types of complex and costly patients may hold greater potential for ‘‘bending the cost curve.’’

This research uses patient-level data and a much richer set of explanatory factors than previous studies to examine key patient, physician, practice, and market characteristics associated with costs of high-cost Medicare beneficiaries, defined as the top 25 percent of beneficiaries arrayed by expected Medicare costs… we estimate determinants of Medicare expenditures (costs) at the beneficiary level….After exclusions, the analysis sample comprised approximately 1.6 million beneficiaries. (more…)

Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: Massachusetts General Hospital and Massachusetts General Physicians Organization (MGH)

Remind Me Again About the CMHCB Medicare Demo…

The CMHCB started in 2005. My recollection is that the demo requirements were extremely similar to the Medicare Health Support (MHS) project, with a few exceptions: 1) Applicants had to include direct care providers (delivery systems, physicians) in their program design, 2) patient populations were significantly smaller than MHS.  Please comment on anything I’m missing.

I’ve included an addendum at the bottom providing more info about this little known and not widely discussed Medicare demo.

…and what was the MGH CMP project for the CMHCB?

(more…)

If you went to their Twitter feed today, here’s what you’d see:

This struck me as a great pictorial representation of the broader challenges the CMS Innovation Center faces:

• They’ve kinda sorta figured out there’s a conversation going on out there — they’ve joined Twitter
• They haven’t figured out that they need to listen:  Following = 0
• They haven’t figured out they they need to talk:  Tweets = 0

I remain hopeful, but the CMS Innovation Center has a long way to go.  Dr. Berwick, opening up this closed organization is going to be the challenge of your lifetime.

Answer:

• “demonstration” — 312 mentions
• “pilot” — 80 mentions

This weekend I’ve been trying to wrap my head around the question “Just what are these demos and pilots in the PPACA all about?” I have been boggled by the sheer number and complexity, and thought I’d share some findings from my first dive.

Why are These Pilots and Demonstrations Important?

(more…)

Gawande retorts: “Is that a bad thing?”

…and he answers his own question by describing the value of pilot programs contained in both the Senate and House versions of health reform legislation.

Is Gawande correct?  Yes and no….

(more…)

Medicare announced today that it is extending its Personal Health Record (PHR) pilot project for residents of Utah and Arizona.

This is a waste of time and taxpayer dollars. Those of you who read my blog know that I’m a big fan of PHRs, but you have to know when you’re backing the wrong approach.

What’s wrong with this pilot project? A lot:

(more…)

In that post I touched briefly on the potential for MAPCI to create effective networks at multiple levels — contracting networks, health IT networks, social and collaborative care networks.  I’d like to expand a bit today…

So, why is Medicare’s participation in MAPCI  and other regional collaboratives such a big deal? Here’s my hypothesis:

Medicare’s non-participation (to-date) in regional payer/provider collaboratives has been a rate limiting factor in the potential to achieve high levels of network effects that drive adoption.

(more…)

Why aren’t primary care physicians expressing similar laments about  the shelving of the MMHD (Medicare Medical Home Demonstration) in favor of the MAPCI (Multi-Payer Advanced Primary Care Initiative).

My colleague Jaan Sidorov, MD and I pick up on no signs of discontent.  Read our essay “Three Years of Medical Home Demonstration Preparation Down the Drain?” on Dr. Sidorov’s blog.

Today’s blog post will tackle:

• Medicare’s biggest change in 40 years?
• The rise of MAPCI
• The fall of MMHD
• Implications/discussion

Medicare’s Biggest Change in 40 Years?

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10/26/2009 – In Washington, the efforts to reform health care and health insurance include proposed legislative language that would have an impact on the Medicare Medical Home Demonstration as described in section 204 of the Tax Relief and Health Care Act of 2006 and amended by section 133 of the Medicare Improvements for Patients and Providers Act of 2008. Specifically, section 1302 of House Bill 3200 contains a provision to repeal this demonstration and replace it with an independent practitioner-based medical home pilot described further in the bill. In addition, the House bill includes a second medical home pilot to evaluate community-based medical home models.

At this time, CMS believes it would be impractical to pursue clearance of the Medicare Medical Home Demonstration, which has been under review at the Office of Management and Budget, given the pending legislation that would repeal it and replace it with a similar pilot. CMS is moving forward with an Administration-initiated demonstration announced by Secretary Sebelius on September 16, 2009, whereby Medicare would partner with existing multi-payer medical home pilots to improve the delivery of care. This demonstration, titled the Multi-Payer Advanced Primary Care Practice Demonstration, would be implemented in 2010.

What does this mean? As one who has followed the MMHD closely, here are some of my top-of-mind reactions:

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The part that’s puzzling to me is the statement that LifeMasters owes $125 M to CMS.  That’s hard to figure…the company only participated in MHS for a few months, and to my knowledge MHS is the only Medicare demo that required guaranteed savings (i.e., payback if targets aren’t hit).  

I really have to stretch my imagination to compute how CMS ran the tab to such an astronomical number. It raises questions around CMS’ good faith as a business “partner”.

Let’s do the math.

(more…)

One bad deal can ruin your day.

Today, LifeMasters filed for Chapter 11 bankruptcy protection.  According to its press release:

“The Chapter 11 filing is the most efficient path for the company to restructure liabilities that are a result of Demonstration Projects previously performed under contracts with the Centers for Medicare and Medicaid Services (CMS), ” said George D. Pillari, President of LifeMasters. Mr. Pillari, named President of LifeMasters today, is a Managing Director of Alvarez & Marsal Healthcare Industry Group, LLC and had been working with the company and its board as a restructuring advisor prior to the filing.

During the last four years, LifeMasters participated in three CMS Demonstration Projects aimed at testing certain disease-management techniques in fee-for-service Medicare and Medicare/Medicaid dually eligible populations. Eight other disease management, health insurance and pharmaceutical companies also participated in these projects. LifeMasters’ involvement in the CMS projects ended earlier this year.

CMS contends that LifeMasters, like other participating organizations, was unable to demonstrate success based on CMS’ study design and measurement methodologies. Similar to its claims against other Demonstration Project contractors, CMS contends that LifeMasters is required to repay to CMS any fees earned in excess of savings generated during the multi-year projects. “Rather than endure a costly and time-consuming legal path to challenge CMS, we have chosen to restructure our CMS and other liabilities through the Chapter 11 process,” Mr. Pillari added.

LifeMasters expects no disruptions in its services to clients and believes it has ample cash on hand to emerge from Chapter 11 as a viable health improvement company.

A Modern Healthcare article contains a link to the bankruptcy filing:

• In one checkbox, the company estimates it has $10 to $50 million of assets
• In another checkbox, the company estimates it has $100 to $500 million of liabilities (to all creditors, not just CMS)
• It lists CMS as it’s largest creditor — $125 million

What happened? First let me acknowledge that I don’t have first-hand specifics of the current bankruptcy filing.  However, many bread crumbs have been dropped along the trail…

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• Political reality dictates that the MMHD must save costs.
• As currently structured, the MMHD cannot achieve cost savings
  • In any given year, only a small percentage of patients account for the vast majority of costs
  • Lessons from previous Medicare disease/care management demonstrations has shown that effective care coordination interventions must be targeted at this population
  • Medicare has structured the MMHD so that any patient with one or more chronic condition is eligible; this includes 86% of all Medicare patients.
  • Physicians will be paid risk-adjusted care coordination fees for this entire population — the 86% of patients with one or more chronic condition.
    The MMHD cannot achieve cost savings. 

Dr. Randy Williams, MD — CEO of Pharos Innovations — has written Part II of this series: The Medicare Medical Home Demonstration: Crawling Out From Under the Rock. It’s insightful and provocative reading!

• As a political matter, the MMHD must save money
• As currently structured, the MMHD cannot save money

Please read my guest post

The Medicare Medical Home Demonstration (MMHD): Between a Rock and a Hard Place

over at Pharos Innovations new blog: The Collaborative Forum.

Is there a way out from between the rock and the hard place?  In Part II of this series, Dr. Randy Williams will discuss options.

Disclosure: Pharos Innovations is a client of Better Health Technologies, LLC.

Download a copy here .  Excerpts from the Executive Summary:

Effective Interventions

Three types of interventions have been demonstrated to be effective in reducing hospitalizations for Medicare beneficiaries with multiple chronic conditions who in general are not cognitively impaired:

• Transitional care interventions in which patients are first engaged while in the hospital and then followed intensively over the 4 – 6 weeks after discharge
• Self-management education interventions that engage patients for 4 -7 weeks in community-based programs designed to “activate” them in the management of their chronic conditions
• Coordinated care interventions that identify patients with chronic conditions at high risk of hospitalization in the coming year, conduct initial assessments and care planning, and provide ongoing monitoring of patients’ symptoms and self-care working with the patient, primary care physician, and caregivers to improve the exchange of information. …In-depth analysis of program details has revealed that six
  key components distinguished the successful…programs from the ineffective ones:

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Warrantee

War`ran*tee"\, noun. A written assurance that some product or service will be provided or will meet certain specifications.

Today when we buy practically any consumer item we expect a warrantee.

What’s the “warrantee” after you are discharged from a hospital?

Last September I wrote a post posing the question “What’s the Best Way to Get Hospitals Involved in Care Coordination? ” The short answer was:  Pay them to do it, take money away when they don’t — make hospitals accountable for their role in avoiding unnecessary readmissions.

President Obama’s FY 2010 Budget begins to project savings from avoiding unnecessary hospital readmissions. “Jumpstarting the Economy and Investing for the Future ”  lays the groundwork for hospitals being required to “warrantee” their services:

Improving Care after Hospitalizations and Reduce Hospital Readmission Rates. Nearly 18 percent of hospitalization of Medicare beneficiaries resulted in the readmission of patients who had been discharged in the hospital within the last 30 days. Sometimes the readmission could not have been prevented, but many of these readmissions are avoidable. To improve this situation, hospitals will receive bundled payments that cover not just the hospitalization, but care from certain post-acute providers the 30 days after the hospitalization, and hospitals with high rates of readmission will be paid less if patients are re-admitted to the hospital within the same 30-day period. This combination of incentives and penalties should lead to better care after a hospital stay and result in fewer readmissions—saving roughly $26 billion of wasted money over 10 years. The money saved will also be contributed to the reserve fund for health care reform. [p.28]

Will this be politically challenging? Not likely…this is a continuation of reforms started under President Bush.

The changes will be profound. (more…)

We have learned that coordinating care of patients — particular care of Medicare patients — is complex and time consuming for physicians.

A breakthrough study quantifies just how complex and challenging care coordination really is.  The study is reported in the February 17 issue of Annals of Internal Medicine and is entitled Primary Care Physicians’ Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination :

We found that in a single year for just fee-for-service Medicare patients, the typical primary care physician needs to coordinate care with 229 other physicians working in 117 different practices…. The number of peers was greater for physicians treating patients with higher chronic illness burden, who may benefit the most from coordination.

My mental visualization of these networks is a series of spider webs.

The authors write that “Coordination involves complex activities that require conscious interactions between providers and between providers and patients, including timely transfer of accurate clinical information, effective communication between the involved parties, and shared decision making.”

The estimate of 229 physicians in 117 different practices is conservative: (more…)

What’s the right metaphor for Medicare Health Support (MHS), CMS’ major experiment with disease management for Medicare beneficiaries?  We prefer to look it as a bridge failure that presents an opportunity to improve future engineering and design.

We’ve now had the time to read, reread, and reread again the very recent report from Research Triangle Institute (RTI) — Evaluation of Phase I of the Medicare Health Support Pilot Program Under Traditional Fee-for-Service Medicare: 18-Month Interim Analysis .  Here’s a listing of our 8 key takeaway points:

1. There’s Sufficient Evidence to Conclude "MHS Didn’t Work As Expected"
2. Some Quality Measures in MHS Improved, Yet Outcomes Didn’t. Why?
3. MHS Suffered Execution Nightmares
4. Ronald Reagan Was Right — “Trust, But Verify”
5. MHS Has Implications for the Medicare Medical Home Demo (MMHD)
6. Be Wary of Claims from Pre-Post Studies
7. Differences Between Medicare and Commercial DM are Dramatic
8. The Guaranteed Savings Model is a Two Edged Sword

Let’s examine these at these one at a time. (more…)

Thomas Wilson, PhD, DrPH

CMS has just released the 2nd Report to Congress evaluating the Medicare Health Support (MHS) program. MHS is Medicare’s most visible and significant demo focusing on chronic disease management.

We’ve been poring over the report and will provide more detailed analysis and implications later this week. This 2nd Report to Congress covers 18 months of data on this 3 year project. It provides far more details and substantiation than RTI’s first report, which only covered 6 months data.

However, there’s nothing in here to change our January 2008 conclusion:  The rumors of MHS’s death have NOT been greatly exaggerated.

Here are the five key findings: (more…)

An email from CMS arrived in my inbox this morning at 2 am.  That email notified me that they have updated the MMHD homepage .  A quick click lead me to 8 new documents containing 155 pages of newly available details on the MMHD.

If you have time to read just ONE document, take a look a this PowerPoint summary of the MMHD — it’s so fresh that it’s dated October 28, 2008.

Based on a quick perusal, here are some highlights about how the MMHD will be structured. To separate fact from opinion, I’ve put brackets [ ] around my commentary:

(more…)

CMS has issued a Medicare Medical Home Demonstration Payment Contractor RFP available on the Federal Business Opportunities website. Thanks to the Google Alert service for digging this out.

For the casual reader, the details of the MMHD are taking shape nicely. CMS and its advisors have obviously spent a lot of time planning for this tremendously important project. If successful, the MMHD can salvage primary care from the jaws of death, rationalize reimbursement policy, and set the world right. Other than that it’s business as usual.

For those of you interested in how the details are unfolding, read on…

The MMHD Payment Contractor RFP has links to 20+ documents, most of which are mumbo jumbo contracting details. Here’s where I found the most useful information describing MMHD developments:

• Statement of Work (SOW), authored by CMS
• Design of the CMS Medical Home Demonstration , authored by Mathematica Policy Research, the Center for Health System Change (CHSC), and the National Committee for Quality Assurance (NCQA); June 19, 2008 (more…)

This goes a long way in explaining Medicare’s seeming lack of enthusiasm for past or future disease management demos with DM companies and/or health plans.

Congratulations doctors!

UPDATE: The doctors might have batted a thousand for quality improvements, but only .400 for getting bonuses.  See  Practices hit Medicare P4P quality targets, but bonuses still fall short , AMNews; September 8, 2008.

The process of updating a PowerPoint forces one to collect one’s thoughts, and I’m glad to share with you the PowerPoint slides along with a few highlights about the evolution of the PCMH. The highlights: (more…)

Patient-Centered Medical Home Model: Overview and Update.

The webinar takes place next Monday, July 28 at 12 Eastern. Click here for details. Hope you can join us.

In brief, Healthways position is that the Centers for Medicare and Medicaid Services (CMS) is statutorily required to expand into Phase II of MHS if Phase I is “successful”. While I’m very sympathetic with Healthways predicament and their frustration with CMS, I’m not optimistic that their tactics are likely to work.

In making the case, Healthways CEO Ben Leedle quoted the legislation authorizing MHS.

For a moment, let’s get legalistic and look closer at this legislation.  What exactly is CMS required to do? (I’ve put the more relevant wording in bold). (more…)

Medicare Finds How Hard It Is to Save Money, The New York Times; April 7, 2008

For One Company, Role in Medicare Experiment Has Hurt Stock, The New York Times; April 7, 2008

Thanks to the continuing opacity of the Centers for Medicare and Medicaid Serices (CMS), we remain confused about the future of Medicare Health Support (MHS).

It’s been over a month since we last commented on MHS. What’s MHS?  It’s JUST the Federal Government’s most significant and visible effort to deal with one of the American health system’s biggest challenges — managing care for patients with chronic diseases.

In late January CMS announced that it planned to end MHS Phase I and did not plan to proceed with MHS Phase II.  Evidence presented to justify that decision was sketchy at best and opaque at worst  – as we wrote previously,  the evidence was “insufficient”.

We are not alone in our confusion and lack of clarity about the future of MHS: (more…)

Despite CMS’ recent cocktail hour pronouncement that Medicare Health Support (MHS) is on its last legs, many are fighting to prolong its life.

Recent Developments

DMAA is working with Sen. John Kerry to introduce legislation mandating the continuation of Medicare Health Support (MHS).  Dr. Jaan Sidorov’s Disease Management Care Blog reprints the full announcement from the February 12 issue of DMAA eNews.  Here’s an excerpt: (more…)

The biggest single contribution of this report is to create a back-of-the-envelope (BOTE) economic model of anticipated costs and benefits from implementing the medical home.  Here’s the bottom line:

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But, what DOES work?

One key lesson emerging from MHS is the need to integrate and engage physicians and other local care providers…easier said than done.

MHS is just one of many experimental approaches being tried by Medicare.  Other approaches include the medical home model, Medicare Advantage plans, Special Needs Plans (SNPs), P4P, and a variety of other Medicare demos and pilot projects.  I’ve been critical of Medicare’s lack of transparency lately, but I applaud their innovation and experimentation.

While we definitely don’t have all the answers, I’d like to bring your attention one company that I believe has the right strategy and mindset: HealthSpring.  HealthSpring owns and operates Medicare Advantage plans in Alabama, Florida, Illinois, Mississippi, Tennessee and Texas and also offers a national stand-alone Medicare prescription drug plan. 

HealthSpring recently conducted an Investor Day meeting with financial analysts.  You can read the entire transcript of the meeting here — warning, it’s about 35 pages long.  I’ve culled through this presentation to dig out some best practices that HealthSpring is employing. 

(more…)

Add the Centers for Medicare and Medicaid Services (CMS) to the growing list of people and organizations who cannot find financial savings through disease management.  Weeks after “lowering the bar” on MHS program savings requirements to 0% from 5%, CMS cancelled the program altogether due to the unlikelihood that the much-reduced threshold for savings would be achieved in the remaining months of the three-year measurement period.

Yet even as CMS’ conclusion mirrors that of the Congressional Budget Office, and the RAND Corporation, other organizations and consultants are finding enough value to justify contract extensions and expansions.  Paradoxically, one such announcement — by Independence Blue Cross — was made within hours of the CMS announcement.

So how is it that well-informed people can look at the same data and come up with dramatically different conclusions and action implications?   One must recall the quote from the immortal philosophers Dire Straits:  “If two men say they’re Jesus, one of them must be wrong.”  (more…)

Last Tuesday during the cocktail hour, CMS issued documents portending the end of the Medicare Health Support (MHS) project.   

We initially used the word “bizarre” to describe the announcement from CMS’ staff.  After further thought, “reckless” and/or “insubordinate” strike closer to home.

First, let’s have the head-honcho at CMS instruct us on how things should be done. In September 2007 Kerry Weems, the new CMS Administrator, declared that “cocktail hour press releases” from his agency must stop, and that a new era of “transparency” and “accountability” must begin.  

So here’s the list of decision criteria we draw from Mr. Weems statement:

1) No cocktail hour press releases

2) Transparency

3) Accountability

Now let’s see how CMS’ announcement ending the MHS program does on these criteria: (more…)

Without pointing fingers, it’s obvious that investors were surprised by the news.  What happened?

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Today’s POO (persistent obfuscatory orations) Award goes to the Centers for Medicare Services (CMS) for their posting of two bizarre documents updating progress on the Medicare Health Support (MHS) program.  The documents “appeared” (no press release, no announcement, a reference to “today” but no date) on the web page for the MHS demonstration project.

While a casual reader would probably review these documents and scratch their head, we interpret them as a death knell for the Medicare Health Support chronic disease management (DM) project and that there will be no MHS Phase II.

As we wrote in our previous essay — Disease Management and the Medicare Health Support (MHS) Project: “Houston, we have a problem” —  we caution readers NOT to generalize this as “DM doesn’t work in Medicare”.  MHS is only one narrow, outdated business model option of how Medicare could choose to address the challenges of chronic disease; the problems are now understood better than ever, and there a number of other alternatives that can and should be tested.

What Did Medicare Say?

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I’m pleased to share a copy of the PowerPoint presentation with you, and I hope you find it useful and provocative.  You can view and/or download a copy here (6MB).  This version contains 77 slides, which would be about the length I’d use for a 3 hour workshop; you’d see a more compact version for a conference keynote, Board summary, or management strategy session.

fyi, the DM Megatrends are:

MAGNITUDE: We are just scratching the surface of chronic disease challenges.
INTEGRATION:  The 50 year tide is shifting toward integration, away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the medical home and the Chronic Care Model.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY:  DM in your home and your pocket.
BEHAVIOR CHANGE: DM is moving from a medical to a social model; behavior change has become the Holy Grail.
CLINICAL AND ECONOMIC ROI:  Round one is over, DM wins; Round 2 has just begun.
WILDCARDS! (employers, P4P, retail clinics, CDHPs, elections)

Comments are always appreciated.

Last week was a podcast of DM Megatrends…next week — the movie.  Brad has signed, Angelina is waffling.

More typically, DM Megatrends is 45–90 minute presentation with accompanying PowerPoint slides.

As part of the Web Summit, the good folks at MCOL asked me to do a short podcast on highlights of this presentation. They’re allowing me to share it with you… click here to save or listen to the podcast.

fyi, the DM Megatrends are:

MAGNITUDE: We are just scratching the surface of chronic disease challenges.
INTEGRATION:  The 50 year tide is shifting toward integration,  away from specialization.
MEDICARE: While Medicare has endorsed the need for chronic disease management, disappointing results from recent demo projects make future direction unclear.
PROVIDERS: Care providers have woken up to DM opportunities and threats; they are promoting the medical home and the Chronic Care Model.
MAKE, ASSEMBLE, BUY? Fewer are buying as health management becomes increasingly strategic.
TECHNOLOGY:  DM in your home and your pocket.
BEHAVIOR CHANGE: DM is moving from a medical to a social model; behavior change has become the Holy Grail.
CLINICAL AND ECONOMIC ROI:  Round one is over, DM wins; Round 2 has just begun.
WILDCARDS! (employers, PHRs, P4P, CDHPs)

Well, that’s finally changing. Today’s POE (plain old English) award is presented to Linda Magno, Director, Medicare Demonstrations at CMS (Centers for Medicare and Medicaid Services).

Here are a couple of slides from Ms. Magno’s presentation at the Patient Centered Primary Care Collaborative Summit on November 7:

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The conventional wisdom in the disease management (DM) community has been that the Medicare Health Support (MHS) project would provide the evidence to resolve two issues:

First, MHS would once-and-for-all resolve the issue of “does DM have ROI? (return on investment).” It was thought that the randomized control trial process employed in MHS would provide scientific evidence to prove that DM has a positive ROI, clearing the way for unqualified acceptance and widespread adoption. (more…)

New Health Plan Strategies for Disease Management: Lessons Learned From the Medicare Health Support Pilot

Click the link for details about the agenda and registration.

The faculty includes:

CHRISTOBEL SELECKY, chairman, president and CEO of LifeMasters Supported SelfCare, Inc.  She also is immediate past president of the Disease Management Association of America (DMAA).

JEAN BISIO, CEO of Green Ribbon Health LLC, a joint-venture company created by Humana Inc. and Pfizer Inc.  Green Ribbon Health serves a nine-county area of Florida and is operating one of the eight Medicare Health Support pilot programs.

(Yours truly)… VINCE KURAITIS, principal and founder of Better Health Technologies.

Please join us for this teleconference sponsored by Atlantic Information Services.

My article — “Disease Management and the Medical Home Model: Competing and Complimentary” — has been published in the latest issue of Disease Management and Health Outcomes, a peer reviewed journal.

I’ve arranged with the publisher to make copies available through my website. You can download a copy here.

Why is this an important topic? Here’s the big picture:

• Current chronic disease management demonstration/pilot projects in Medicare are showing little evidence of success.
• Physicians have woken up to threats and opportunities relating to chronic disease management and care coordination. The Medical Home model is a unified proposal by primary care physicians to define the next generation of primary care.

How will these trends interact? Your thoughts are welcomed, and please feel free to comment on the article.

The first “official” results from the Medicare Health Support (MHS) disease management (DM) pilot projects were published last week.  While the results are preliminary, there is virtually no evidence of any early success.  Here are three key findings from the executive summary of the report:

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Again, the findings show minimal evidence of success in any of the Medicare DM programs. Several of the slides from Randall Brown of Mathematica cut to the chase:

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TO DO

1) George says everybody’s gotta have an EHR by 2014

• tougher than getting a man to the moon in the 60s
• stall — G will be gone by then

2) solve chronic disease crisis

• chronic disease costs are killing us, 5% of seniors account for 50% of costs
• baby boomers hit the fan in 2010
• note to self — drop the cheeseburger at lunch

3) solve primary care crisis

• species could disappear from the continent
• docs are really pissed
• note to self — fire the bonehead that decided to pay specialists 3x more in the first place

4) pick up drycleaning

….etc., etc.

“This is a heckuva list…I wondering if there’s any way to shorten it?

(more…)

In April Medicare announced roll out of its DOQ-IT U (Doctor’s Office Quality — Information Technology University), as a part of the Physician Focused Quality Initiative. DOQ-IT U is an interactive, Web-based tool designed to provide solo and small-to-medium sized physician practices with the education for successful Electronic Health Record (EHR) adoption, including lessons on culture change, vendor selection and operational redesign.

Implementing EHRs in physician practices will be a key element of success in physician-led chronic care projects. How successful have pilots of DOQ-IT University been at getting physicians to adopt EHRs?

(more…)

The World Health Care Blog is a unique experiment sponsored by the World Health Care Congress.  Please also check out the excellent health care blogs of my fellow bloggers:

Tony Chen at Hospital Impact

Emily Devoto at The Antidote: Counterspin for Health Care and Health News

Matthew Holt at The Health Care Blog

Derek Lowe at In the Pipeline

David Williams at Health Business Blog

Today’s POO (persistent obfuscatory orations) Award goes to Healthways for their explanation of  MHS progress (or lack thereof) in an April 4 press release.  If you can understand what they’re saying about MHS (see p. 3) without having your CPA explain it, you’re a lot smarter than I am:

The recently received sixth quarterly CMS report for the MHS pilots continued to cumulatively reflect minimal separation between the intervention and control groups as measured under the terms of our current Cooperative Agreement with CMS, which resulted in a net reversal of revenues of approximately $1.9 million.

Over the past 90 days, the Company has been actively engaged with CMS in mutual and intensive analysis of intervention and control group data in order to better understand the factors associated with CMS reported performance and to identify mutually acceptable modifications to the pilots that would enhance the likelihood of overall success and progression to Phase II….

Huh?

Today’s POE  (plain old English) Award goes to Lehman Brothers analyst Joshua Raskin. Here is his April 5 summary of Healthways’ news:

(more…)

Section F of the Executive Summary is entitled “Synthesizing the Findings: What Works, and What Doesn’t”.  That section begins:

Given that few of the programs have shown convincing evidence to date of reducing beneficiaries’ need for hospitalizations and saving money or of improving the quality of care received, there is relatively little assessment that can be done yet of  what works.[xxxii]

The Medicare Coordinated Care Demonstration (MCCD) is one of a series of Medicare demonstration projects that have been going on for a decade.  Many of these projects relate to chronic care management.  However, don’t confuse the MCCD with the more widely known Medicare Health Support project, which is also experiencing some early bumps.

The MCCD projects began operations in 2002. The15 awardees include “five commercial disease management vendors, three
hospitals, three academic medical centers, an integrated delivery system, a hospice, a long-term care facility, and a retirement community… The 15 programs differed widely in both how they implemented their care coordination interventions with patients and their involvement with patients’ physicians and other providers”

Other key findings from the 230 page report:

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Disease Management (DM): Will Providers Seize the Opportunity to Be Back in Charge?

Click the link for details about the agenda and registration   You can receive a 15% discount by entering the following Promotional Code:   0412VK

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The testimony was presented on March 1 by Byron Thames, MD, an AARP Board member. With over 35 million members, AARP is the leading nonprofit, nonpartisan membership organization for people age 50 and over in the United States.

Here are my take-away points from Dr. Thames testimony:

• AARP recognizes that addressing care coordination is a critical issue in health care payment reform
• AARP is on the fence about who should do care coordination
• AARP could have an influential role in payment reform (more…)

Please allow me to elaborate.

P4P programs are based on two assumptions:

1. Patients are assigned to a physician or a practice that will have primary responsibility for their care, and
2. That a meaningful fraction of the care physicians deliver is for patients from whom they have primary responsibility

Wouldn’t you expect that this would be problematic for older (Medicare) patients who see multiple doctors over time? How can you assign accountability for performance to one doctor when the patient is seeing a number of doctors for a number of care episodes? (That’s the BFO part for me.) and wouldn’t you expect this to be even more problematic for patients with multiple,chronic conditions?

Shouldn’t somebody study this to figure out whether P4P is doable in Medicare? Well, they have. (more…)

Well, it’s happening.

Four physician organizations representing 330,000 doctors issued a press release voicing their support for Joint Principles of a Patient-Centered Medical Home. The four groups are the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA).

So? (more…)