You Can Lead a Senior to Water but…..

The Centers for Medicare & Medicaid Services launched the Medicare Health Support pilot project three years ago hiring eight private disease management firms to set up voluntary chronic care improvement programs for beneficiaries. At its height 150,000 seniors were enrolled in the program. 68,000 beneficiaries still receive services.

By using trained nurses or health coaches to contact patients
and remind them to check their vital statistics and take their
medications, among other activities, the companies encouraged
the seniors to take better care of themselves between office visits.
The desired result was fewer unnecessary hospitalizations and
emergency department trips.

CMS has determined that the pilot was not meeting the statutory requirement that enrollees’ Medicare claims amounts be lower than or equal to those for a control group of seniors who were not enrolled in the project. Three of the original eight disease management companies dropped out before their three years was up. Medicare Health Support will terminate in December and not be renewed unless the five remaining firms help slash enrollees’ Medicare claims by $600 to $800 per participant per month from now until the contracts end.

So is the focus on costs clouding the fact that some quality improvements have been made? Apparently so according to physicians fighting to keep the program alive, citing for example some improvements in quality scores for seniors in Western Pennsylvania. Another problem seems to be the availability of data on enrollees that could help the disease management companies better gauge what they have to provide and how far they have to improve the health of the beneficiary. Indeed improvements have been made just perhaps not within the cost metric that CMS wanted so it is hard to tell if the program truly worked at its core mission level. And apparently beneficiaries chosen for these services may indeed have been too sick for them to do much good. Physicians say a redesigned program would need to involve physicians heavily in choosing which beneficiaries would benefit from the chronic care services.

So perhaps this is the right intentioned program with the wrong carrot. In any case it would be great to see some of the empirical evidence on quality improvement as well as hear the anecdotal stories of seniors helped by it. It would be a shame to thwart something that is finally wellness and not sickness related. What do you think?