Officials for the disease-management industry last week challenged CMS claims that participants failed to meet savings criteria in a pilot that has been indefinitely suspended.
Participants in the agency's Medicare Health Support three-year pilot project were authorized to test chronic-care management alternatives on fee-for-service Medicare beneficiaries with heart failure or diabetes. According to the CMS, Phase 1 of the pilot failed to meet its criteria on improving clinical quality and beneficiary satisfaction, and achieving target savings. The program was established by the Medicare Modernization Act of 2003 as a two-phased initiative, although the CMS has decided to hold off on Phase 2 until an evaluation of the entire Phase 1 project is finished, in 2011 or 2012.
The five participating companies have been notified in the meantime that the services they're providing under this pilot project will have to come to an end at the end of their contract period, said CMS spokesman Peter Ashkenaz. All of the contracts expire this year.
Yet, the industry contends that some of the methodologies used by the agency in this pilot were flawed and that it was unfair for the CMS to temporarily halt the project, since that leaves 68,000 beneficiaries without needed services. The goal of Medicare Health Support was to provide a more holistic approach to working with diabetics and heart attack patients in traditional fee-for-service Medicare.
The program was well-intentioned, but it was underbudgeted and did not have sufficient staff or expertise to pull this off, said George Bennett, chairman and chief executive officer of Health Dialog Services Corp., one of the care-management firms participating in Phase 1 of the pilot.
In a letter to CMS acting Administrator Kerry Weems, Healthways President and CEO Ben Leedle Jr. wrote that his chronic-care program would meet or exceed the statutory requirements in the pilot, based on Healthways' own analysis. Leedle also took issue with the pilot's design, beneficiary selection and randomization process, including the fact that CMS did not deliver the pilot population that it was contractually obligated to provide, he wrote.