Medicare Health Support Research Articles

Medicare Health Support Pilot Program.

Medicare Health Support Pilot Program.

Results of the Medicare Health Support Disease-Management Pilot Program

In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program. The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries. The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures. In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.

Analysis of the Treatment Effect of Healthways' Medicare Health Support Phase 1 Pilot on Medicare Costs

The objective of this analysis is to evaluate the treatment effect of Healthways' Medicare Health Support Pilot Program on total Medicare expenditures. Previous studies have analyzed the first 6 months of the program for all Medicare Health Support Organizations. The purpose of this analysis is to supplement and extend the previous work. The policy question addressed in this article is whether, on net, the intervention lowered total Medicare expenditures. The study was a retrospective analysis of data claims and membership databases. We used ordinary least squares regression techniques to estimate the effect of the intervention on total costs. We also stratified the data using risk scores calculated prior to the intervention. Our analysis found that the intervention consistently had little or no effect across the entire sample, but was associated with a statistically significant decrease in spending when the analysis concentrated on the sample that fully participated in the program. Overall, our analysis finds that total annual Medicare costs for the participating sample were 15.7% lower in 2007 ($3240) than for the control group, controlling for age, sex, race, and baseline risk. On balance, our analysis supports a conclusion that the program did successfully reduce costs for its target population. We find that Medicare expenditures were lower among enrollees in the program than they would have been without the intervention. This article shows that significant cost reductions among high-cost, chronically ill Medicare beneficiaries are possible.

A Review of Healthways' Medicare Health Support Program and Final Results for Two Cohorts

Chronic care management programs have been shown to offer a scalable approach for improving health and reducing health care costs in commercially insured populations. Medicare Health Support (MHS) was a government-sponsored program designed to determine whether that success could be translated to a Medicare fee-for-service population with complex chronic diseases. The purpose of this article is to provide an overview of MHS and its Phase I study design, and to review the officially reported outcomes of the arm of the study in which Healthways, Inc. provided program services. MHS employed a block randomized design; consent was requested after randomization and evaluation included all eligible individuals, irrespective of that consent. Healthways accepted 2 study cohorts. The first cohort included beneficiaries with diabetes and/or heart failure (Intervention, N=19,936; Control, N=9995) for a 3-year study period. The second cohort entered after 1 year and included beneficiaries with heart failure, with or without diabetes (Intervention, N=4238; Control, N=2106). Comparisons of total health care spending between the Intervention and Control groups found gross savings of $3.8 and $5.7 million for the first and second Intervention cohorts, respectively, and these savings exceeded program costs for the second cohort. Improvements in evaluated clinical measures were demonstrated in the first Intervention cohort, and overall program satisfaction was 94%. Clinical measures and satisfaction were not evaluated for the second cohort. These results indicate that Healthways successfully adapted its commercial chronic care management program for a Medicare fee-for-service population and achieved high satisfaction, improved clinical measures, and financial savings.

Avoiding Randomization Failure in Program Evaluation, with Application to the Medicare Health Support Program

We highlight common problems in the application of random treatment assignment in large-scale program evaluation. Random assignment is the defining feature of modern experimental design, yet errors in design, implementation, and analysis often result in real-world applications not benefiting from its advantages. The errors discussed here cover the control of variability, levels of randomization, size of treatment arms, and power to detect causal effects, as well as the many problems that commonly lead to post-treatment bias. We illustrate these issues by identifying numerous serious errors in the Medicare Health Support evaluation and offering recommendations to improve the design and analysis of this and other large-scale randomized experiments.

Lessons For The New CMS Innovation Center From The Medicare Health Support Program

The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program that ran between 2005 and 2008, illustrate the value of drawing on experience in planning for the center and future pilot programs. The lessons include the importance of strong leadership; collaboration and flexibility to foster innovation; receptivity of beneficiaries to care management; and the need for timely data on patients' status. The lessons also highlight pitfalls to be avoided in planning future pilot programs, such as flawed strategies for selecting populations to target when testing payment and service delivery reforms.

Healthcare Costs Associated with Depression in Medically Ill Fee‐for‐Service Medicare Participants

To examine the association between depression and healthcare costs in medically ill fee-for-service (FFS) Medicare recipients. Observational analysis of Medicare claims data. Medicare Health Support (MHS) program at Green Ribbon Health. Fourteen thousand nine hundred two participants with diabetes mellitus, congestive heart failure (CHF), or both. This study examined participant data for a 12-month period before MHS enrollment (collected between November 2004 and August 2006). Twelve-month healthcare costs (based on Medicare claims) in 2,108 participants with International Classification of Diseases, Ninth Revision, claims diagnoses of depression, 1,081 participants with possible depression (positive depression screen on the two-item Patient Health Questionnaire or self reported antidepressant use), and 11,713 participants without depression were compared. Gamma regression models were used to adjust for demographic and clinical differences and nonnormal distribution of cost data. Participants with depression had significantly higher total healthcare costs than those without ($20,046 vs $11,956; P<.01). Higher costs were observed in participants with depression in every cost category except specialty mental health care, which accounted for less than 1% of total healthcare costs. Participants with depression had higher costs in each quartile of increasing medical severity (measured using the Charlson Comorbidity Index). These differences remained statistically significant after adjusting for demographic and other clinical differences. Depression is associated with significantly higher healthcare costs in FFS Medicare recipients with diabetes mellitus and CHF. Only a small proportion of the increased costs are spent on mental health specialty care.

Disease Management and the Medical Home Model

For the past decade, US physicians have failed to embrace disease management (DM) approaches offered by private DM companies and health plans. Until recently, physicians have not offered an alternative, systematic approach to caring for patients with chronic illnesses and conditions. The medical home model has become the centerpiece of reforms proposed by associations that represent family medicine physicians (the American Academy of Family Physicians [AAFP]) and general internal medicine physicians (the American College of Physicians [ACP]). In February 2007, the AAFP and the ACP were joined by the American Academy of Pediatrics and the American Osteopathic Association in issuing joint principles for the patient-centered medical home. While the medical home model is promoted primarily as a comprehensive approach to primary care reform, there is one aspect where the medical home and DM overlap: care coordination. Medicare has been exploring alternative mechanisms to manage and reimburse chronic care and care-coordination activities. In 2003, the US Congress passed legislation to require pilot projects for chronic care improvement programs; the program implementing this legislation is Medicare Health Support (MHS). To date, very little information has been available about the progress of MHS projects. The three early announcements about MHS progress have not been encouraging: the expected financial results are not being achieved. In December 2006, Congress passed legislation authorizing the Medicare Medical Home Demonstration (MMHD) project. MHS and MMHD are directed at similar patient populations: high-cost, frail, elderly patients with multiple co-morbid conditions. The medical home concept being advanced by primary care physicians has the potential to be competitive with DM companies. Health plans that have built their own DM programs are more likely to be supportive of the medical home model. Do physicians have the ability to compete at providing care-coordination services? There are strong arguments suggesting ‘no’ and strong arguments suggesting ‘yes’. While the medical home model is focused on primary care reform, its effect could be competitive to DM companies and others. The medical home model could affect the flow of hundreds of billions of dollars — money that over time might flow either to physicians or to private companies.

CMS Launches Disease Management Models

CMS Launches Disease Management Models

Medicare Health Support: Reinventing Chronic Care

Medicare Health Support is a groundbreaking new initiative to help chronically ill Medicare beneficiaries improve their health and quality of life. If the ongoing pilot programs are successful, they may have far-reaching effects on population health and patient care.

You can't get there from here: obstacles to improving care of the chronically ill.

Commentary Health AffairsVol. 20, No. 6: Chronic Care In America You Can’t Get There From Here: Obstacles To Improving Care Of The Chronically IllBruce C. VladeckPUBLISHED:November/December 2001No Accesshttps://doi.org/10.1377/hlthaff.20.6.175AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSChronic diseaseChronic careMedicare savings programsMedicaidElderly careGovernment programs and policiesMedicare eligibilityOrganization of careManaged care plansMedicare Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 10 History Published online 1 November 2001 InformationCopyright 2001 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited ByElectronic medical record system avoidance in a turbulent environmentInformation & Management, Vol. 53, No. 5Individual and Contextual-Level Factors Associated with Continuity of Care for Adults with Schizophrenia21 May 2013 | Administration and Policy in Mental Health and Mental Health Services Research, Vol. 41, No. 5Results of the Promoting Effective Advance Care Planning for Elders (PEACE) Randomized Pilot StudyPopulation Health Management, Vol. 17, No. 2Improving Hypertension Control in a Population of Low-Income Frail Older Adults21 December 2010 | Journal of Applied Gerontology, Vol. 31, No. 4Results of the Medicare Health Support Disease-Management Pilot ProgramNew England Journal of Medicine, Vol. 365, No. 18Ecological Aging: The Settings Approach in Aged Living and Care Accommodation28 May 2008 | EcoHealth, Vol. 5, No. 2COMORBID MEDICAL ILLNESSES AND PERCEIVED GENERAL HEALTH AMONG ADULT RECIPIENTS OF MEDICAID MENTAL HEALTH SERVICES9 July 2009 | Issues in Mental Health Nursing, Vol. 28, No. 3The Impact of Comorbid Chronic Conditions on Diabetes CareDiabetes Care, Vol. 29, No. 3Improving the Outcomes of Heart Failure Care⁎⁎Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.Journal of the American College of Cardiology, Vol. 45, No. 10SERVICE SYSTEM INTEGRATION: PANACEA FOR CHRONIC CARE POPULATIONS?