Thursday, April 30, 2009

A Chronic Care Management Innovation Center Is a Lousy Idea: Warning Will Robinson!

Much like the Jupiter 2 in the campy ‘60s TV series Lost In Space, the Senate Finance Committee is risking going off course into Deep Space on the topic of care management. It released a 52 page paper two days ago describing ‘policy options’ designed to ‘set forth’ ideas on ways to revise payment systems and policies in the Medicare program. It has 5 sections on 1) improving quality and promoting primary care, 2) fostering care coordination and provider collaboration, 3) health care infrastructure investments, 4) Medicare Advantage and 5) combating fraud.

The Disease Management Care Blog zeroed in on the topic of fostering care coordination. While this section also addressed bundling payments to reduce inpatient readmissions as well as transitioning from fee-for-service to ‘accountable care,’ it was a loopy option to create a ‘Chronic Care Management Innovation Center’ (‘CMIC’) that caught the DMCB’s eye. CMIC? Another acronym? Another Department in an already sprawling bureaucracy?

Recall that CMS can test potential reforms under a mechanism called ‘demonstrations’ and that there are about thirty of them currently underway. This option would enshrine perpetual demos under a permanently established Center. This CMIC would be charged with conducting a continuous quest for models of care that include patient centeredness, focusing on ‘in-person contact’ with beneficiaries, self care and teaming around primary care providers. In addition, a ‘Rapid Learning Network’ (RLN) consisting of a network of providers that would participate in these demos would be created on a competitive basis.

Ay carumba! The DMCB thinks this is a lousy idea. While demonstrations under a CMIS are one important tool that enables CMS to examine the merits of a care approach, they:

a) are inefficient and time-consuming, often resulting in the reporting of results long after continuous medical innovation has rendered the original approach obsolete

b) are unable to address the multiple social, cultural and regional dimensions of care management,

c) render opaque complex data that are prone to endless picayune interpretations that fail to disprove instead of succeeding to prove,

d) centralize the conduct of scientific investigation under a Federal entity that, despite the RLN, will be aligned with the interests of large academic institutions that stifle alternative points of view, research methods, audience needs and market demand

e) presuppose that demos are the best, if not only, route to testing chronic care models and finally

f) suggests that the patient centeredness, teaming with non-physician providers, and patient self care are still topics of research.

According to the paper, ‘the Committee is seeking input from members, CBO, and CMS on the design, score, and implementation of the options proposed in this section.’ While it is disappointed that it wasn't also asked for input, the DMCB nonetheless hopes that someone with the ear of the Committee includes the catch phrase ‘Danger, Will Robinson!’

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