Disease management advocates remain optimistic that nurse-based health coaching and other health support programs can improve outcomes and lower costs despite a damaging new report on a CMS pilot project.
The CMS report to Congress evaluated the first 18 months of the three-year demonstration program involving about 240,000 heart failure and diabetes patients enrolled in Medicare fee-for-service. Researchers found that the program, called Medical Health Support, did not reduce hospitalizations, mortality rates or lower costs.
None of the Medical Health Support pilot programs at the midpoint of the pilot have yet to meet the three statutory requirements: to improve clinical quality of care and beneficiary satisfaction and achieve budget neutrality with respect to their fees, wrote researchers from RTI International, who conducted the report to Congress for the CMS. The findings echoed an initial report on the pilot, issued in 2007.
Eight companies signed on to provide disease-management support to the beneficiaries at sites across the nation beginning in 2005 and 2006. But during the second year, three companies dropped out, citing concerns that the 5% savings requirements, plus cost savings to cover their fees, were too ambitious. Two other companies later requested early termination before the end of the program. The final pilot ended in August 2008. Participating vendors were Aetna, Cigna Corp., Green Ribbon Health, Health Dialog, Healthways, LifeMasters, McKesson Health Solutions and XLHealth.
DMAA: The Care Continuum Alliance, a not-for-profit consortium of disease management advocates and companies, said that it was disappointed in the CMS findings, and that they contradicted other experiences by private pay and Medicaid enrollees.
Disease-management advocates also expressed hope that the final report on the three-year project, due in 2011, will show positive improvements.
I do believe this runs counter to what is known about disease management, said Gordon Norman, executive vice president of science and innovation and chief science officer at Alere, a Reno, Nev.-based disease management company, and board chairman of the DMAA.
Norman suggested that there may have been too much lag time between getting initial information on enrollees and interventions, and that data sources for the program might have been insufficient. In addition, participants ran the gamut in terms of their level of health, making it difficult to tailor interventions, he said. Alere did not participate in the program.
Recruiting the sickest of the Medicare fee-for-service beneficiaries proved difficult, according to the report.
There were some bright spots. Across 40 care measures, there was a modest improvement in 16 measures, in the range of 2 to 4 percentage points, according to the report.