Mathematica Researchers Summarize Disappointing Results Across 4 Medicare DM Demonstrations

Presenting at the Annual Academy Health Research Meeting earlier this week, representatives from  Mathematica Research and CMS (Centers for Medicare and Medicare Services) presented findings across several Medicare disease management (DM) demonstration/pilot programs. 

Again, the findings show minimal evidence of success in any of the Medicare DM programs. Several of the slides from Randall Brown of Mathematica cut to the chase:

Findings from Four (Medicare DM) Demonstrations

* No effects on adherence or self-care
* Only 3 of the 20 programs reduced hospitalizations or gross costs (4.5% reduction in MCC admissions)
     – Another had effects for CHF subgroup in urban counties
* No effects on mortality
* Scattered modest effects on quality indicators:
     – CHF:  MCC reduced preventable hospitalizations
     – Diabetes:  Telemedicine improved HbA1c, cholesterol, blood pressure; MCC reduced preventable hospitalizations
* Patients love the programs

Why Doesn’t DM Work Better?

Changing patient and provider behavior is HARD:
     – Limited use of behavior change models
     – No incentive for physicians to communicate
Some patients too ill, others not at short-run risk:
     – But targeting is not the major problem
Programs don’t collect timely hospitalization and Rx info
Usual care providers are minimally engaged
Programs led by marketers, not clinical experts:
     – Ineffective use of available data  
     – Unfamiliar with unique needs of the elderly
Contact info poor in population-based models
* Improvements in quality of care don’t guarantee better patient outcomes in short run

This is the most straightforward and concise summary of Medicare DM progress that I’ve ever seen!

Here are links to all the PowerPoint presentations:

Lessons from CMS Disease Management Initiatives

Chair: Linda Magno, Centers for Medicare and Medicaid Services

Panelists:

Mary Kapp, Centers for Medicare & Medicaid Services
PowerPoint Slides | PDF Handout of Slides

Randall Brown, Mathematica Policy Research
PowerPoint Slides | PDF Handout of Slides

Samuel Simon, Mathematica Policy Research
PowerPoint Slides | PDF Handout of Slides

Ronnie Tan, Centers for Medicare & Medicaid Services
PowerPoint Slides | PDF Handout of Slides