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Medicare/Care Coordination
Three Years Of Medical Home Demonstration Preparation Down the Drain?
Do you remember the scene in the movie Animal House where Bluto Blutarski laments “…seven years of college education down the drain?”
Why aren’t primary care physicians expressing similar laments about  the shelving of the MMHD (Medicare Medical Home Demonstration) in favor of the MAPCI (Multi-Payer Advanced Primary Care Initiative).
My colleague Jaan Sidorov, MD and I pick up on no signs of discontent. Read our essay “Three Years of Medical Home Demonstration Preparation Down the Drain?” on Dr. Sidorov’s blog.
Medicare’s Biggest Change in 40 Years on the Horizon?
Earlier this week CMS issued a typically cryptic Announcement indicating that they were shelving the Medicare Medical Home Demonstration (MMHD) and instead would focus on the recently announced Multi-Payer Advanced Primary Care Initiative (MAPCI). My blog post from Tuesday provides details and asks the question “What does all this mean?”
Today’s blog post will tackle:
Medicare’s biggest change in 40 years?
The rise of MAPCI
The fall of MMHD
Implications/discussion
Medicare’s Biggest Change in 40 Years?
CMS Shelves Medicare Medical Home Demonstration
I just received an email from CMSÂ announcing the latest official word on the Medicare Medical Home Demonstration (MMHD):
10/26/2009 – In Washington, the efforts to reform health care and health insurance include proposed legislative language that would have an impact on the Medicare Medical Home Demonstration as described in section 204 of the Tax Relief and Health Care Act of 2006 and amended by section 133 of the Medicare Improvements for Patients and Providers Act of 2008. Specifically, section 1302 of […]
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). Â
I really have to stretch my imagination to compute how CMS ran the tab to such an astronomical number. It raises […]
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 […]
Part II — The Medicare Medical Home Demonstration: Crawling Out From Under the Rock
In Part I of my guest post on The Collaborative Forum blog, I wrote that the Medicare Medical Home Demo is in BIG Trouble. Here’s a recap:
Political reality dictates that the MMHD must save costs.
As currently structured, the MMHD cannot achieve cost savings
In any given year, only a small percentage of patients account for the vast majority of costs
Lessons from previous Medicare disease/care management demonstrations has shown that effective care coordination interventions must be targeted at this population
Medicare has structured the […]
Medicare Medical Home Demo (MMHD) is in BIG Trouble
Between the time the MMHD was authorized in 2006 and now, we’ve learned a lot about what works and what doesn’t work in Medicare care coordination programs. The MMHD is between a rock and a hard place — conflicted by two “must achieve” objectives that are diametrically opposed:
As a political matter, the MMHD must save money
As currently structured, the MMHD cannot save money
Please read my guest post
The Medicare Medical Home Demonstration (MMHD): Between a Rock and a Hard Place
over at […]
Landmark Report: “The Promise of Care Coordination” in Medicare
Download a copy here . Excerpts from the Executive Summary:
Effective Interventions
Three types of interventions have been demonstrated to be effective in reducing hospitalizations for Medicare beneficiaries with multiple chronic conditions who in general are not cognitively impaired:
Transitional care interventions in which patients are first engaged while in the hospital and then followed intensively over the 4 – 6 weeks after discharge
Self-management education interventions that engage patients for 4 -7 weeks in community-based programs designed to “activate” them in […]
Obama Budget: Hospitals Should Warrantee Admissions for 30 Days
Warrantee
War`ran*tee", noun. A written assurance that some product or service will be provided or will meet certain specifications.
Today when we buy practically any consumer item we expect a warrantee.
What’s the “warrantee” after you are discharged from a hospital?
Last September I wrote a post posing the question “What’s the Best Way to Get Hospitals Involved in Care Coordination? ” The short answer was: Pay them to do it, take money away when they don’t — make hospitals accountable for their […]
Spider Webs of Care Coordination Networks
We have learned that coordinating care of patients — particular care of Medicare patients — is complex and time consuming for physicians.
A breakthrough study quantifies just how complex and challenging care coordination really is.  The study is reported in the February 17 issue of Annals of Internal Medicine and is entitled Primary Care Physicians’ Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination :
We found that in a single year for just fee-for-service Medicare patients, the typical primary care physician needs […]