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The demise of Medicare Health Support

I guess we knew it, but here’s the confirmation in the analysis of the first 18 months from CMS.

The summary: DM companies in Medicare Health Support enrolled healthier than average populations; they had limited to no impact on improving their patients’ care, satisfaction or outcomes; and didn’t save any money.

I wonder how Disease Management is going to fare in the future. It’s clear that this "occasional remote intervention" model needs to change.

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4 replies »

  1. Sever personal liability including loss of coverage and death.
    You only have to watch a couple non compliant diabetics lose their feet then legs then die before you realize taking care of one’s health is a personal issue and regardless of your efforts some people will refuse to participate. The question then is how much should society spend treating these people who don’t care themselves?
    It’s a decision no politician will ever make and one the more Altruistic will deny even needs discussion but it is a real issue. I have cients that have begged employees to get help and done everything possible to get them help they refuse to participate in while costing the plan hundreds of thousands a year. Wouldn’t that money be more efficiently spent treating and saving lives that want to be?
    Failure to participate in DM and comply with reasonable goals should result in loss of insurance and treatment. Cold but such is reality sometimes.

  2. Maggie, you point out an unfortunate irony in the MHS project.
    When the RFP was released, it read “come one, come all” and encouraged any interested parties to submit proposals. Over 500 people attended the initial bidders conference in person and another 200 listened on the phone. The interested group represented virtually every sector of health care.
    The “guaranteed-savings model” of MHS is familiar only to DM companies and health plans. In essence, contractors are at risk at forfeiting up to 100% of their fees if they did not hit satisfaction, outcome, AND financial targets.
    Once they understood the risks of this reimbursement model, providers turned the other direction.
    Ultimately all the awardees of MHS contracts were either health plans or DM companies.
    As it turns out, it looks like MHS contractors will indeed be paying back almost all the “fees” they received up front.
    This is a two edged sword. On the one hand, taxpayers arguably “benefit” because the health plans and DM companies took the business risk (and lost).
    On the other hand, as you point, other potential models of DM — especially ones driven by providers — were not incentivized or selected.
    Personally, I conclude that the bigger risk is the loss of innovation in limiting the awardees of MHS to being large DM companies and health plans. Now, 5 years later, we’ve learned a lot a lot about what approaches for DM don’t work in Medicare, but little about what will work. ….and the next big thing (demo) is to test the Medical Home model in Medicare. Check back in 2014.

  3. I would note that this pilot was attempting to improve outcomes and save money within a fee-for-service model.
    I wonder if the results would have been different if
    large multi-speciality medical centers where doctors work on salalry (and collaborate with each other) had
    run the programs. . ..

  4. Clearly both the model and the beneficiaries need to change. Sadly, success will only come with more intense intervention because people just don’t seem to want to be bothered with maintaining their health these days. I’m being a little harsh there, but’s it’s a reality that is playing out more and more every year.
    As someone that reads Health Affairs, I’m sure you read the Sept/Oct issue that had a few articles challenging the current physician practice business model. I thought it was great reading and I agree that other models must develop to fit specific conditions. DM companies are a great concept, there just needs to be some tweaking to their approach.

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