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:

Healthways CEO Ben Leedle: “What we don’t know any more than you do is where that data came from or have the opportunity for CMS to share with us how they came to those conclusions. …I really can’t comment on that only because I can’t draw any conclusion around it until I understand directly from CMS how they arrived at those numbers and for what time periods they arrived for it and what was their work done in being able to calculate relative trend lines and the rate of change that has to occur with remaining months.” [Healthways Earnings Call Transcript; March 18, 2008 (transcript courtesy of Seeking Alpha)]

Four U.S. Senators in a letter to CMS Administrator Kerry Weems requesting continuation of MHS:  “As we understand it, the methodology employed by CMS in making these statements is un-validated, incomplete and open to interpretations, rather than specific data as required” [DMAA eNews; March 18, 2008 quoting from a letter written by Sens. Edward M. Kennedy, D-Mass., John Kerry, D-Mass., Lamar Alexander, R-Tenn., and Bob Corker, R-Tenn]. The Disease Management Care Blog hints at the coincidence that these four Senators come from the states of Tennessee and Massachusetts (which happen to be home for two of the MHS vendors).

CMS spokesperson Peter Ashkenaz: the agency plans to work “as expeditiously as possible” on the evaluation of the program and that all organizations involved “knew that the program was to be evaluated before CMS could proceed to the next phase” [Kaiser Daily Health Policy Report; March 18, 2008]

Well, that settles that — NOT! (with apologies to Wayne’s World). 

We saw the first (and only) MHS evaluation released when the project was two years old; that evaluation only reported on data for the first six months of the project. Will it be another two years before a final evaluation is released?   

We’ll continue to keep you informed of non-developments as they occur.

2 thoughts on “The Medicare Health Support Saga: Opacity in Government Going Strong

  1. CMS, you would think, would want to cut its budget by keeping people healthier and out of the hospital. That’s a crucial assumption, since it’s the DM industry’s business model.

    Au contraire.

    CMS is composed of bureaucrats who all want to keep their jobs. No bureaucrat wants his/her budget cut, since that would mean a proportional loss of their own jobs.

    Never mind the money or the lives of the patients wasted.

    Until CMS is made much more accountable, e.g. with an Ombudsman and something approaching public transparency, we taxpayers might as well get used to the idea that we’re paying for an abomination.

  2. More than ten years ago the John A Hartford Foundation supported a number of projects that attempted to improve primary care for the frail elderly throuh the use of case managers (RNs or MSWs) to work with primary care physicians. The goal was to manage chronic disease, maintain Activities of Daily Living, and so avoid nusing home admissions and ER visits and produce some cost savings. The results were published in Enhancing Primary Care of Elderly People by Ellen Netting and Frank Williams.

    There was no one-year payback from the projects. At best some of the projects produced enough savings towards the end of the second year to cover their costs.

    Ony one of the organizations continued the project – a rural multi-specialty group which viewed that it hada captive population.

    There is a solution to this problem: have Medicare Advantage members enroll for a three year period. The one-year churn causes plans to insist on a one-year payback on disease management and case management efforts. That is simply too short when trying to work with the frail elderly.

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