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?

“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?

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.

Medicare Health Support (MHS) Claims Another Victim: LifeMasters Files for Chapter 11

Updated 6:10 pm, September 14, 2009

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…

Medicare Health Support: 8 Takeaways on Building Better Bridges

by Thomas Wilson, PhD, DrPH and Vince Kuraitis

Engineer

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.

CMS Releases 2nd Report on Medicare Health Support

by Vince Kuraitis and 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:

Finally! CMS Provides a Flood of Details About the Medicare Medical Home Demo

Flood I’ve been critical in the past when CMS has been silent in explaining their thinking, so I’ll start this post by congratulating CMS on sharing a flood of details about the upcoming Medicare Medical Home Demonstration project.

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:

Details “Emerge” on the Medicare Medical Home Demonstration

Where would one expect to find CMS’ latest thinking on the upcoming Medicare Medical Home Demonstration project? The obvious answer would be “on the Official CMS MMHD home page ”, but you’d be wrong.

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:

Medical Home PowerPoint and Latest Perspectives

Last week my esteemed colleague Dr. Jaan Sidorov and I conducted a webinar for WRG on Patient Centered Medical Home (PCMH) developments.

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:

The Medical Home: Pull the RUC Out

This third and final post in the series addresses questions about the future of the Patient Centered Medical Home (PCHM):

  • What’s problematic about using the RUC methodology with the PCMH?
  • What’s the optimal level for a PCMH care management fee?
  • Should primary care leaders pull the RUC out? How?

What’s Problematic About Using the RUC Methodology with the PCMH?

There are at least two reasons for not having the RUC methodology seen anywhere in the same county country as the PCMH. First, the RUC methodology doesn’t account for technology and services needed for optimal care management. Second, the RUC methodology is conceptually flawed.

1) The RUC methodology doesn’t account for technology and services needed for optimal care management. Here’s what the RUC recommended methodology for the PCMH pays for:

Table of contents for The Medical Home: End of the Honeymoon

  1. The Medical Home: Confusion Over Care Management Fees
  2. The Medical Home Hits the RUC
  3. The Medical Home: Pull the RUC Out
  4. Extra: Will $87 Per Hour Rescue Primary Care?