Lifemasters Bankruptcy: Will CMS Earn Reputation as a Good Business Partner or Thug?

In my post from Monday on LifeMasters seeking Chapter 11, I dropped a BTW comment.

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.

How Much Health-Related Productivity Loss is Really Avoidable? And Why Should I Care??

by John E. Riedel

Study breaks new ground in calculating the "normal impairment factor."

John Riedel We know that poor health accounts for a considerable amount of productivity loss-anywhere from 1 ½ to 3 times direct medical costs.  The potential for disease prevention and disease management programs to reduce productivity loss has, for obvious reasons, caught the attention of healthcare purchasers.  But let’s be careful about making big claims to "recapture" productivity loss.  People find it tough to change health behaviors.  And, even if someone is perfectly healthy, they aren’t 100% productive 100% of the time!  (Possibly with the exception of the current reader.)

Although the association between poor health and reduced productivity is reportedly quite high, employers don’t know how much productivity loss can realistically be recaptured .  There is a need to quantify the portion of productivity loss that can be regained through health management strategies.

Without knowing that amount of impairment, employers and their population health management providers can’t set realistic objectives for their health and productivity strategies.  A recently published article in the Journal of Occupational and Environmental Medicine (Riedel et al with StayWell Health Management) sheds some light on this issue.

Complimentary Webinar on Comparative Effectiveness Sponsored by Population Health Impact Institute (PHII)

The message is clear from Washington – “Comparative Effectiveness” has been proposed as the foundation for coverage decisions in Medicare.  As the feds lead – this will more than likely "trickle down" to the commercial sector.

The Population Health Impact Institute (PHII) has convened national experts to develop a practical, comparative-based system to help purchasers and payers evaluate the methods and results used in all kinds of population health management programs – including medical, case and disease management, benefit design, value-based purchasing and more.

Join us on Thursday, December 18 at 2:00 pm (EST) for a one-hour complimentary webinar to learn more about the PHII Methods Evaluation Process™ (MEP), including the:

Guest Post: The CMS Announcement Of Medicare Health Support Program Cancellation — What It Means For Buyers

by Al Lewis, JD

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.” 

The PowerPoint — DM Megatrends 2008

Last week I did the major annual tune-up of my presentation on Disease Management Megatrends for the MCOL Future Care Web Summit

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.

Podcast: The 20 Minute Version of “DM Megatrends”

Over the past week I’ve been doing a major tune-up of my presentation on Disease Management Megatrends for the annual MCOL Future Care Web Summit

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)