This announcement made the Disease Management Blog ask just what is the species known as a Medicare/Medicaid “demonstration?” With the aid of some buddies, I was able to take a guided bus tour of the topic around the web. I’ve learned to think of them as “field tests” that typically involve a waiver of existing CMS regulations that assess whether a change will lead to better efficiency or quality. Referred to as “demos” for short, they can be approved by Congress (usually as a part of a legislative package) or initiated by CMS under a provision in the law that gives the Secretary of HHS “demonstration authority.” Even if a demo is approved, however, funding is by no means guaranteed. Those bucks may have to come via Congress through a separate bill. Funding may also come out of other existing pots of money, but they often need approval by other entities such as the Office of Management and Budget. (As an aside, the disease management blog wonders if this could account for some of the radio silence on the Medical Home Demo, but I digress)
Then it’s up to CMS to author the specific language that actually kicks off the demo. This language includes the request for proposals (RFP), which are published in the Federal Register. It takes full-time insiders to anticipate coming demos or read the Register. Either that or a prescription for Ritalin. Not all demos are necessarily awarded through a public bidding process. They can be awarded to a specific entity (a favorite approach is earmarks) or written so narrowly that any competition is nil.
Companies pursue RFPs for several reasons, including the chance to prove to CMS that a waiver should be made permanent or their product or service deserves to be permanently covered by Medicare. It can also lead to other demos, especially if the previous track record is good. It can also generate some important PR, such as the attention of the Disease Management Care Blog. Companies also gain considerable experience in delivering their product or service. While the economic payoff in the short term may not be that great, if CMS ultimately decides to include the product or service as a permanent part of the Medicare benefit, the payoff can be huge.
With some trepidation, the Disease Management Blog donned his trusty dive suit and entered the CMS demo web site. It found a ten page list of 52 demos (5 are closed). More details on the Health Dialog announcement can be found here. It looks like this will be a three arm randomized trial where beneficiaries will be assigned to either 1) a health risk assessment (HRA) questionnaire plus generic healthy life style advice, 2) an HRA plus advice tailored to the HRA or 3) an HRA plus intensive counseling. Participants will also be linked to other community based health promotion programs.
It appears Health Dialog was not only awardee. The others are Focused Health Solutions, HealthPartners, Pfizer Health Solutions and StayWell Health Management. It begins in April of 2008, and will end in September of 2011.