“Disease Management” RIP

The Care Continuum Alliance has mercifully and wisely rebranded it’s name and eliminated the initials “DMAA”. See its press release: Care Continuum Alliance Launches New Brand for Population Health Improvement. (As a reminder, DMAA originally stood for Disease Management Association of America.)

I for one say “hurrah, and good riddance”.

Where Did the Term “Disease Management” (DM) Trip Up?

“The Innovator’s Prescription”: Christensen’s Book Offers Insightful Dx, Unrealistic Rx

by Vince Kuraitis and David C. Kibbe MD, MBA

Ip Being big fans of Clay Christensen and his theory of disruptive innovation (DI), we have been awaiting his just-released book The Innovator’s Prescription: A Disruptive Solution for Healthcare .  The book is co-authored by Dr. Jerome Grossman and Dr. Jason Hwang.

We have mixed reactions.

The book is mistitled. It should have been titled "The Innovator’s Diagnosis". The book does a fantastic job at diagnosis (Dx) of problems in the U.S. health care system. It presents many new, innovative analytical frameworks and lenses through which to view the U.S. health system.

However, it’s weak on prescription (Rx): many of the proposed solutions are speculative, ungrounded, and/or defy political reality.

We understand that the very nature of disruptive innovation implies inevitable resistance from organizations that benefit economically from the status quo. But at some point a proposed solution becomes so disruptive that you have to suspend reality to believe that it could be adopted or implemented — and many proposed solutions in this book enter that realm.

Healthways Fights an Uphill Battle on Medicare Health Support Phase II

Earlier this week Healthways issued a press release describing their progress in pursuing a Phase II Medicare Health Support (MHS) project.   Read Dr. Jaan Sidorov’s blog commentary for additional background.

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).

The Medicare Health Support Saga: Opacity in Government Going Strong

 Vince Kuraitis and Thomas Wilson, PhD, DrPH

“If you aren’t confused you don’t know what’s going on.”
Jack Welch, former CEO, General Electric


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:

Medicare Health Support: “Do not go gentle into that good night”

Vince Kuraitis and Thomas Wilson, PhD, DrPH

“Do not go gentle into that good night.
Rage, rage against the dying of the light”
Dylan Thomas


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:

HealthSpring “Gets” Physician Engagement.

I’ve written a lot recently about Medicare Health Support (MHS).  We are learning a lot from MHS about what DOESN’T work with the frail, elderly Medicare population.


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. 

Insufficient Evidence to End Medicare Health Support

Thomas Wilson, PhD, DrPH and Vince Kuraitis

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:

$389 M of Healthways’ Market Value Vaporizes After CMS Announcement. What Happened?

Healthways stock price declined today by $10.52 (15.9%) after CMS “announcement” about ending Medicare Health Support (MHS) Phase 1.  This equates to a loss of $389 million in market capitalization…poof!  Gone. Healthways is one of the remaining five participants in the MHS program.

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

Four Misconceptions About HealthVault and the Emerging Personal Health Information Ecosystem (PHI-Ecosystem)

by Vince Kuraitis and David C. Kibbe, MD MBA 

The health care and technology worlds are still trying to figure out what Microsoft’s HealthVault (HV) is all about.  We believe that there are a number of misconceptions out there about what HV is and isn’t:

Misconception #1: HealthVault is a personal health record (PHR).

Misconception #2: People don’t trust Microsoft, so they won’t sign up for and use HV.

Misconception #3: Patients don’t understand PHRs, don’t want them, and don’t know what they’d do with them.  This is a rate limiting step to market growth for HV and its partners.

Misconception #4: By launching HealthVault first, Microsoft beats Google to the punch.

Let’s take these one at a time.

Yet Another Dark Cloud in the Stormy Skies of Medicare DM

Medicare’s major thrust at chronic disease management innovation — the Medicare Health Support (MHS) pilot project — continues to gather storm clouds.

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….


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