Subscribe if you want to be notified of new blog posts. You will receive an email confirming your subscription.

Please enter your name.
Please enter a valid email address.

Please check the captcha to verify you are not a robot.

Something went wrong. Please check your entries and try again.

MGH Medicare Disease/Care Management Demo Shows Home Run Results!

Medicare has (finally) recently released a report showing home run results for a disease/care management demonstration project!

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?

The Massachusetts General Hospital and the Massachusetts General Physicians Organization (MGH) Care Management Program (CMP) was one of the awardees of a CMS CMHCB demonstration project (enough initials yet?)

MGH’s CMHCB demonstration program involves providing practice-based care management (PBCM) services to high-cost Medicare FFS beneficiaries. Case managers, who are assigned to each MGH physician office, develop relationships with program participants to provide support across the continuum of care. The Massachusetts General Physicians Organization (MGPO), the largest multi-specialty group practice in New England, provides the overall administration and underlying structure in delivering integrated care management services under the CMP. Case managers provide patient education and connect patients with resources to address medical and psychosocial needs to help prevent acute exacerbations of disease and associated inpatient admissions and emergency room visits. The program also includes components to address mental health issues, evaluate complex pharmaceutical regimens, and support end-of-life decision making.

Key Findings

Key Finding #1: MGH’s CMP achieved a high participation level that reached broadly across its intervention population…

Key Finding #2: MGH’s CMP successfully targeted beneficiaries with high rates of acute care utilization.

Key Finding #3: MGH’s CMP improved beneficiary reported satisfaction with helpfulness of discussions and communication with their health care team….

Key Finding #4: MGH’s CMP improved primary care provider (PCP) assessment of the quality of medical practice and quality of care for their patients.

Key Finding #5: MGH’s CMP did not improve the rate of compliance in four quality-of-care process measures.

Key Finding #6: MGH’s CMP was successful reducing the rate of increase in acute care hospitalizations and ER visits but not 90-day readmissions. MGH’s CMP did not impact use of the Medicare hospice benefit.

Key Finding #7: MGH’s CMP was successful at reducing the mortality rate within the intervention group of beneficiaries.

Key Finding #8: MGH’s CMP achieved substantial, statistically significant savings. The Medicare program’s return on investment (ROI) was 2.65 for MGH’s original intervention group and 3.35 for MGH’s refresh intervention group.

What Worked?

From the “Conclusions” section of the executive summary:

What might explain the observed success in MGH’s demonstration program? Two explanations may be the depth of institutional support to (1) develop an MGH-specific program, and (2) to fully integrate the CMP into MGH’s health care system. Based upon interviews with senior MGH and CMP leadership, it was noted that from the beginning the CMP had the complete backing from the Board of Trustees and hospital and physician leadership.

Some additional nuggets provide additional insight:

…strong integration support from MGH leadership afforded the case managers physical entry into the primary care practice settings whereby the case managers were co-located with the primary care physicians ultimately becoming a part of the beneficiaries’ primary health care teams.

…the CMP was able to marshal a wide range of MGH internal resources to more fully develop particular aspects of their program that were tailored to the needs of the MGH patient population.

Another critical element of integration was the use of MGH’s information technology (IT) system to support CMP operations.

CMP leadership recognized prior to launch of its program that its population would require case managers with substantial experience in dealing with frail and medically complex patients.

Commentary — A Home Run!

Finally…a major success story!

The financial results (which have been deal breakers in most previous Medicare disease/care management demos) are particularly noteworthy:

…substantial, statistically significant, savings were found for the intervention in the original population. Relative costs (or gross savings) rose -$288 slower in the original intervention group (12.1% of monthly comparison costs); yet needed to exceed just 6.8% to be considered statistically significant at the 95% confidence level. For every dollar invested in MGH’s CMP management fees, Medicare received $2.65 in savings on beneficiary health care services.

If anything, MGH’s CMP performed even better with its refresh population. Gross savings averaged -$355 (15.8% of comparison monthly costs). Based on an average monthly management fee of $120 paid on 84% of participating intervention eligibles, Medicare’s return on investment was 3.35. For every management dollar spent, Medicare received $3.35 in return in the form of lower cost increases.

A big “Congratulations” go out to the MGH CMP team!

Addendum: More About the CMHCB Medicare Demo

Finding information about this demo on the CMS website is more confusing than trying to find Waldo.

The CMHCB Medicare home page is sparse and incomplete. It does not include information about the project RFP, proposals, or results.

Here’s how Medicare’s 2009 CMHCB project summary describes the demo:

The Care Management for High Cost Beneficiaries (CMHCB) Demonstration was approved to provide disease management services for thousands of beneficiaries by awarding six organizations with populations in sizes from 1,800 to 15,000. The 3-year demonstration tests provider-based intensive care management services as a way to improve quality of care and reduce costs for fee-for-service beneficiaries who have one or more chronic diseases and generally incur high Medicare costs. The sites were chosen in different areas of the country, with the primary focus on disease states of congestive heart failure (CHF), diabetes, and/or chronic kidney disease (CKD).

Initial awards were made to 6 organizations:

  1. Care Level Management (CLM)
  2. VillageHealth (formerly known as RMS) and its Key to Better Health program (KTBH)
  3. The Health Buddy® Consortium (HBC), composed of Robert Bosch Health Care (RBHC, formerly known as the Health Hero Network), the American Medical Group Association (AMGA), Bend Memorial Clinic, and Wenatchee Valley Medical Center
  4. Texas Tech University Health Sciences Center (TTUHSC) and its Texas Senior Trails (TST) program
  5. Montefiore Medical Center (MMC)
  6. Massachusetts General Hospital and Massachusetts General Physicians Organization (MGH) and its Care Management Program (CMP)

In January 2009 CMS granted project extensions to three awardees: Key to Better Health, a division of Village Health; Massachusetts General Care Management Program; and Health Hero Network, Health Buddy Project

To my knowledge, CMS has released CMHCB project evaluations for two other awardees, both of which produced train-wreck results:

Finally, while the print date on the MGH CMHCB is September 2010, I just found out about it today.  Hattip to HealthHombre!  If you have better information about Waldo’s whereabouts, please comment below.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 Unported License. Feel free to republish this post with attribution.

8 Comments

  1. Alltop Health on December 2, 2010 at 6:30 pm

    MGH Medicare Disease/Care Management Demo Shows Home Run Results! http://bit.ly/hv32uD



  2. Aparna M K on December 3, 2010 at 4:03 am

    MGH Medicare Disease/Care Management Demo Shows Home Run Results! | e-CareManagement Blog http://dlvr.it/9fG17



  3. Vince Kuraitis on December 3, 2010 at 9:36 am

    MGH Medicare Disease/Care Management Demo Shows Home Run Results! e-CareManagement blog http://bit.ly/gbK8zd #healthreform #hcr



  4. Gregg Masters on December 3, 2010 at 10:27 am

    RT @VinceKuraitis: MGH Medicare Disease/Care Management Demo Shows Home Run Results! http://bit.ly/gbK8zd #healthreform #hcr



  5. geoffclapp on December 3, 2010 at 10:39 am

    RT @2healthguru: RT @VinceKuraitis: MGH Medicare Disease/Care Management Demo Shows Home Run Results! http://bit.ly/gbK8zd #healthrefor …



  6. geoffclapp on December 3, 2010 at 5:39 pm

    RT @2healthguru: RT @VinceKuraitis: MGH Medicare Disease/Care Management Demo Shows Home Run Results! http://bit.ly/gbK8zd #healthrefor …



  7. David Williams on December 8, 2010 at 4:04 pm

    RT @VinceKuraitis: MGH Medicare Disease/Care Management Demo Shows Home Run Results! http://bit.ly/hxvgPs



  8. Vandy IHI Chapter on December 9, 2010 at 7:08 am

    RT @HealthBizBlog: RT @VinceKuraitis: MGH Medicare Disease/Care Management Demo Shows Home Run Results! http://bit.ly/hxvgPs