Vince Kuraitis and Thomas Wilson, PhD, DrPH
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 MHS is only one narrow, outdated business model option of how Medicare could choose to address the challenges of chronic disease; the problems are now understood better than ever, and there a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?
The two documents that appeared on Medicare’s web site are entitled Fact Sheet – Completion of Phase I of Medicare Health Support Program and Completion of Phase I of Medicare Health Support Program FAQs. They make for some confusing reading.
Here’s some key language from the Fact Sheet:
The experience of the MHS program indicates that Phase I of the program is not meeting the statutory requirements of improved clinical quality outcomes, improved beneficiary satisfaction, and the achievement of financial savings targets. Based on the results of the independent evaluation of all of the Phase I programs, CMS will consider whether to expand to Phase II.
One of the goals of the MHS program is to see a reduction in Medicare claims costs for the intervention group. To date there has been nominal impact on Medicare claims costs as a result of the MHS program. At the level of individual organizations, some MHS programs show increases while others show modest decreases in Medicare claims costs. However, to achieve budget neutrality, the five MHSOs in current operation need to reduce Medicare claims costs by between $300 and $800 per participant per month for the remaining months of the pilot program. This represents a 20 to 40 percent reduction in claims costs from the current levels that are being billed.
…and from the FAQ document:
The statute limits Phase I to three years and makes expansion to Phase II contingent on a program (or components of such program) improving the clinical quality of care, improving beneficiary satisfaction, and achieving targets for savings. Unless all three of those conditions are met, there is no authority to begin Phase II.
What Does Medicare Mean?
Here’s our interpretation of what CMS is saying:
MHS is not meeting targets for financial savings. While it is theoretically possible that the MHS program could climb out of the hole financially during the remaining months of the program, we are doubtful that this will happen — so much so that we are scheduling the patient’s (MHS’) funeral even though technically we are not allowed to pronounce the patient dead yet. In the event that hell freezes over and the program revives, we will then schedule Phase II, but don’t hold your breath.
In a new twist on an old saying by Mark Twain: The rumors of MHS’ death have NOT been greatly exaggerated.
Article Series - CMS Bumps Off Medicare Health Support
- CMS: “Rumors of Medicare Health Support’s Death Have Not Been Greatly Exaggerated”
- $389 M of Healthways’ Market Value Vaporizes After CMS Announcement. What Happened?
- Insufficient Evidence to End Medicare Health Support
- Guest Post: The CMS Announcement Of Medicare Health Support Program Cancellation — What It Means For Buyers
- Medicare Health Support: “Do not go gentle into that good night”
- The Medicare Health Support Saga: Opacity in Government Going Strong
- NYT Provides More “Enlightened Ambiguity” on Medicare Health Support
- Healthways Fights an Uphill Battle on Medicare Health Support Phase II
- CMS Releases 2nd Report on Medicare Health Support
- Medicare Health Support: 8 Takeaways on Building Better Bridges
- Medicare Health Support (MHS) Claims Another Victim: LifeMasters Files for Chapter 11
- Lifemasters Bankruptcy: Will CMS Earn Reputation as a Good Business Partner or Thug?
Related Posts (# comments)
Tags: business model, disease management, HIE, Medicare, Medicare Health Support