Medicare Health Support Announcement

CMS has announced that Phase I of Medicare Health Support is unlikely to achieve budget neutrality and is not meeting the statutory requirements for demonstrated savings. In addition, it has concluded that there have been only nominal improvements in clinical quality and beneficiary satisfaction. As a result, Phase I will be allowed to end without any plan in place to begin Phase II. Phase I will end after three years of operations between July and December of 2008.

The Disease Management Blog expects there will be significant commentary about this in the coming days. It'll be "inside the beltway" over the next 24 hours and will spill over to the national arena in the days that follow. Given the coming cacophony, this blog can't resist adding its $.02................................................................

We're learning that legislating the conduct of randomized clinical trials is very cumbersome. While there may be no evidence of savings, the ability to discern the savings has been significantly compromised by several key methodological issues that are turning out to be insurmountable. Key word: bias.

In addition, what isn't true in the Medicare FFS population may still be true in other populations. Key word: generalizability.

Finally, the Ver. 1 model of disease management tested in MHS is becoming increasingly obsolete. In the opinion of the disease mangement blog, better predictive modeling with more robust and tailored behavioral approaches are continuing to transform the industry. Include better collaborative integration with the best elements of the Advanced Medical Home, pay for performance, electronic health records and flexible insurance benefit designs, the possibilities for real transformation of chronic illness care remain truly exciting. Key word: don'tthrowthebabyoutwiththebathwater.