You’ve Gotta Spend Money to Save Money …

Or so the thought is by many in the health care world.

Thus, the motivation for chronic care management programs was born.

CMS, the august government body charged with overseeing Medicare (and Medicaid), instituted a 3 year, $360 million, test program to see if these programs would have the effect of saving the system money.

The conclusion after the 3 years:

Using regular phone contact to check on the health of chronically ill U.S. Medicare patients appears to cost more than it saves the system.

More from the article: "[t]he problem is that the fees paid to the companies make the program uneconomic."  (Note that a longer version is available at the NY Times website here.)

My favorite part of the UPI brief: "Sens. John Kerry, D-Mass., and Lamar Alexander, R-Tenn., are pressing for its continuation. Companies involved in the program are based in both of their states."

First: sounds a lot like the need to ‘overpay’ private companies for Medicare services under the Medicare Advantage program.

Second: I am waiting for the dissembling by those who do not see any ‘politics as usual’ in that the brave, well-intentioned politicians (from both parties) are more driven by political expediency—the desire to pass your money (actually, it is your grandchildren’s, but what is a couple of generations of debt, really) onto their voting and donating constituents.  The vaunted ‘evidence based’ approach plays no role (and will always be second fiddle to the bureaucrat-controlled world of ‘healthcare-by-lobbyist™’.

Third: At what point will those who tout the savings of a massive expenditure on ‘chronic disease management’ consider that they ought to preface their comments and claims with "we hope"? (political strategists take note: there are the makings of a catchy phrase here.)

Before the usual suspects accuse me of wanting to maintain the status quo to line my own pocket (a comment that is always guaranteed with nearly all of my posts), I do not doubt that if people took better care of themselves, the system would save some money. Please note that I have used the ‘intensive noun’, themselves, rather than using a phrase like government-paid contractors who are motivated to keep patients dependent upon their services, which happen to include chronic disease management and advice.

(Full disclosure: I guess I can be accused of being a government-paid contractor through my Medicare agreement.)

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5 replies »

  1. What this teaches us is something the commercial market has understood for a long time.
    It takes a long time and a lot of effort to get a chronically ill person under medical management to where their cost to the system is, if not reduced, at least predictable. Any actual cost savings — e.g. a heart attack prevented — may not be realized for decades, especially in the Medicare population where the person may die of something else before they die of whatever you’re trying to prevent with preventive medicine.
    This is why commercial insurers have no incentive to get serious about disease management and would rather sell you a PPO than an HMO. The average worker changes employers every three years, and the average company might change insurers as well if the rates go up too much or a new boss comes in or a merger/acquisition takes place. So if Blue Cross is your insurer right now, where’s their interest in helping prevent you from having a heart attack 10 years from now when you’re working for another company, living in another state, or covered by, say, United?

  2. Most telling is the fact that they were paying $2000 a year for each patient. The people making the calls were ‘trying’ to call monthly and had a workload of 30-40 calls a day. By some rough maths… they were paying $150 per call and each nurse was generating $5000 a day in fees. Somehow I doubt that they were actually paying the nurses this much money.
    This looks like typical political pork rather than ‘disease management’.

  3. Good post Eric. I think you’re finally getting it.
    “With health costs soaring, few would dispute that the government needs to find better ways to spend its Medicare dollars. But because the system relies heavily on private industry and is subject to Congressional oversight, few changes come easily, and even experimental programs can take on lives of their own.”
    We won’t fix healthcare until we fix government.

  4. Apparently Healthways and Medicare can’t agree on what preventive care is or which patients would benefit from disease management enough to save money for Medicare? Quality of care doesn’t seem to matter to Medicare.

  5. > The vaunted ‘evidence based’ approach plays no
    > role (and will always be second fiddle to the
    > bureaucrat-controlled world of ‘healthcare-by-
    > lobbyist™’.
    Sigh. Probably so. At least until we once again have an army of nuns to look after those who cannot or will not look after themselves.