Healthcare Business News

Senators press CMS on disease-management pilot program

Posted: March 17, 2008 - 4:15 pm ET

Four senators who are heavily involved in federal health policy have called on the CMS to reverse its decision to end a nascent disease-management pilot program, saying that the agency’s decision was based partly on “unvalidated, incomplete” data.

The CMS last month tabled plans to continue its three-year Medicare Health Support program after early results showed that participating companies had failed to meet certain quality, cost and beneficiary-satisfaction goals.

“We are concerned that suspending, even temporarily, the nation’s broadest care-management program for Medicare fee-for-service beneficiaries makes no clinical or fiscal sense,” Sens. Lamar Alexander (R-Tenn.), Bob Corker (R-Tenn.), Edward Kennedy (D-Mass.) and John Kerry (D-Mass.) stated in a letter sent to the CMS. “The beneficiaries participating in Phase I pilots are satisfied with the service, and are receiving demonstrably improved care as a result.”

The thrust of the program was for care-management companies to adapt their proven, cost-saving disease-coordination methods to the Medicare population. The five participating companies—Aetna Health Management, Green Ribbon Health, Health Dialog Services Corp., Healthways and XLHealth Corp.—provide direct advice, education, medication management and other personal services to patients who suffer from heart disease or diabetes. More than 150,000 Medicare beneficiaries were part of the pilot program.

Healthways President and Chief Executive Officer Ben Leedle Jr. last month told the CMS that the program would “meet or exceed” statutory goals despite problems with patient selection and other issues with the beneficiary population. -- by Matthew DoBias

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