The early returns from a CMS pilot program that aims to better coordinate and manage care for chronically ill patients fails to show significant financial savings, and the program has put the participating companies at risk of potentially losing money, according to a report sent to Congress last week. Two of the original eight companies selected for the pilot program recently withdrew, citingin parthard-to-reach savings demands by the CMS.
Additionally, the report found relatively small disparities that nevertheless could make it even more difficult for the companies involved in the three-year pilot program to succeed. The report was the first of four that will be sent to Congress on the Medicare Health Support, or MHS, pilot program.
In its findings, RTI International said that at the six-month point fees paid to the MHS programs have far exceeded any savings produced up to now, and detailed that Medicare beneficiaries who volunteered for the program have ultimately cost Medicare more money than those in a control, or comparison, group.
As RTI indicated repeatedly in its report, the congressionally mandated MHS initiative, formerly known as the Voluntary Chronic Care Improvement Pilot Program, is still very much in its infancy. Indeed, six companies in the program have reported only three to five months worth of databarely a ripple in the complex task of treating difficult patients. And everyone involved, from the RTI researchers to CMS officials and company executives, warn that it is premature to draw any definitive conclusions about the initiative.
Still, the results underscore what the CMS and everyone else has known all along: That the difficulties in introducing proven care-management techniques to hard-to-treat Medicare patients are myriad and success is hard to measure.
Weve seen the report and note that in as much as its based on six months of data, we think it is really too early to tell about the success of the pilot program, which is designed to test what kind of interventions work best to help the chronically ill stay well, CMS spokesman Jeff Nelligan said.
The catch, however, is that if the companies dont reach the designated savings threshold, theyll have to pay the agency back potentially millions of dollars in fees collected each month from the CMS.
The participants, including Cigna Health Support, Green Ribbon Health, Health Dialog Services Corp., Healthways, LifeMasters Supported SelfCare and XLHealth Corp. launched their programs between August 2005 and January 2006, in Maryland, Tennessee, Washington, D.C., and parts of Florida, Georgia, Illinois and Pennsylvania.
The goal is to provide a more holistic approach to working with diabetics and heart attack patients in Medicares traditional fee-for-service program. Each program provides patients with over-the-telephone or in-person management services, including health advice, education and coaching and medication management services provided by nurses. Many of these services have long been offered in private-sector disease-management programs and even in some Medicare and Medicaid populations, but traditional Medicare has yet to incorporate them into their sicker patient populations.
Originally mandated by the Medicare Modernization Act of 2003, which saw the program as a break-even initiative, the CMS decided early on to attach a net savings threshold of 5%, meaning that the programs would have to generate a 5% per-member, per-month savings over those patients in a comparison, or control group. The CMS pays up to $159 per patient each month.
But that threshold led at least one program to withdraw from the pilot, and contributed to anothers pullout as well.
Christobel Selecky, president and chief executive of LifeMasters, said that LifeMasters originally wanted to run a program in Oklahoma, but realized almost immediately that the setup and preliminary work to launch the program was too complicated and too risky to chance having to pay the CMS back its monthly fees.
CMS selected a very sick patient population, Selecky said. Because these people dont have any access that youd have in managed care, we ... had to build the kind of infrastructure youd have in a managed environment, she added.
LifeMasters, however, still has a pilot program in the Chicago area.
Sandeep Wadhwa, vice president of care management services at McKesson Health Solutions, said the company decided to withdraw from a demo in Mississippi even though it was beneficial to patients because the CMS rules kept hidden the data the comparison group was achieving. We had thought we would have more ability to do some real-time benchmarking against the control group in order to really modify our approaches in real time so we could learn and adapt. That was a poor assumption on our part, Wadhwa said.
Selecky said she had similar concerns as well. The CMS has since relaxed its policy on sharing comparative data with the programs, she said.