News about Medicare Health Support

The DMAA has a press release hailing Medicare Health Support’s (MHS) announcement that it will not require the 5% savings with fees at risk. Why is this important?

1) It portends a favorable prognosis for the active and flexible continuation of MHS. If Medicare intended to let MHS whither, insisting on 5% would have been a way to do it. This is a sign that there is real interest in giving fee-for-service Medicare disease management a chance to demonstrate what it can and cannot do.

2) Lacking definitive proof from randomized clinical trials of cost savings, this is another indication that the predominant value proposition for disease management in general may be shifting from “there is no certainty about higher health care quality at lower cost” to “there is a reasonable belief in higher health care quality at same – or maybe lower - cost.”

3) It changes the level of evidence required from a positive to a negative. It’s one thing to prove that there was a 5% trend reduction in Medicare claims, it’s another to prove that there wasn’t an adverse impact on trend.

4) Organizations currently in MHS are more likely to remain.

5) It will lower the threshold for other organizations to participate in MHS in the future.

6) If you shorted Healthways, you lost money. That stock chart above is from their web site.