Comments on: The Medicare Health Support Saga: Opacity in Government Going Strong http://e-CareManagement.com/the-medicare-health-support-saga-opacity-in-government-going-strong/ Chronic Disease Management • Technology • Strategy • Issues and Trends Fri, 11 May 2012 15:46:50 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Bradford Kirkman-Liff http://e-CareManagement.com/the-medicare-health-support-saga-opacity-in-government-going-strong/comment-page-1/#comment-8209 Bradford Kirkman-Liff Wed, 26 Mar 2008 15:25:52 +0000 http://e-CareManagement.com/the-medicare-health-support-saga-opacity-in-government-going-strong/#comment-8209 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. 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.

]]> By: Dave Moskowitz MD FACP http://e-CareManagement.com/the-medicare-health-support-saga-opacity-in-government-going-strong/comment-page-1/#comment-8144 Dave Moskowitz MD FACP Mon, 24 Mar 2008 14:52:52 +0000 http://e-CareManagement.com/the-medicare-health-support-saga-opacity-in-government-going-strong/#comment-8144 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. 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.

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