Monday, December 1, 2008

LifeMasters Hits One Out of the Park with Florida Dual Eligibles

While the Disease Management Care Blog was at the Hollywood Florida Forum 08 DMAA meeting, it heard the folks from LifeMasters report on the updated results of a three year randomized (in a ratio of 5:2) clinical trial of opt-out disease management vs. usual care for dually eligible FFS Medicare beneficiaries with heart failure, coronary artery disease and diabetes in eleven counties southern Florida.

By way of background, LifeMasters is a privately held company headquartered in Irvine California. Not too long ago, it stumbled during an attempt at a merger with Healthways. It shuffled its leadership, sought out additional financing, reduced its workforce and decided to stick to disease management.

The Florida program started out in January 2005 with a well defined population with a well defined program of telephonic outreach. As the months progressed, it looked like the program was not going to break even. As a result, LifeMasters changed course. It increased its face-to-face recruitment strategies, dropped four of the counties from the program, changed the combination of chronic illness and comorbidities that qualified for program entry, increased the physician marketing and intensified the remote recruitment efforts.

As a result, recruitment (the number of patients who agreed to participate) and engagement (the number of patients that actually participated in the phone calls) rates went up. Among the persons who were engaged, there was a savings of approximately $700 PMPM vs. persons who had been merely enrolled and vs. the control group patients.

Whoa! you say? The DMCB knows what you’re thinking: that a $700 per member per month (PMPM) savings among the persons that were recruited into the program is a classic example of selection bias. While that’s correct, the analysis reported at the DMAA also included a comparison of the intervention vs. the control groups. The group randomized to the LifeMasters program had lower claims expense compared to the control group; it’s just that the $700 persons who were recruited and engaged ‘dragged down’ the average claims for the entire group, which was otherwise flat. The actual overall savings were not shared at the DMAA meeting (pending release by CMS), but Ms. Selecky’s grin and CMS' decision to extend the program spoke volumes about the results.

The message was that once persons with chronic illness are enrolled, savings are achieved. The fix is to launch disease management programs and enroll, enroll, enroll.

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