|
COMMENTARY -- LIFEMASTERS PULLS THE PLUG ON OKLAHOMA MEDICARE HEALTH
SUPPORT PROJECT
Christobel Selecky,
Executive Chairman of Lifemasters, announced yesterday that
Lifemasters was ending participation in its Oklahoma
Medicare Health Support
(MHS) project. The announcement was made to an audience at the Care
Continuum Congress held in Washington, D.C.
Lessons Learned
Bottom line:
Lifemasters concluded that they would not be able to meet program
goals of a 5% cost reduction.
As measured against
a control group, MHS contractors have guaranteed a 5% savings to
Medicare; contractors that don't achieve savings are at-risk of
having to pay back up to 100% of the fees that Medicare paid them.
Selecky's candid
presentation highlighted lessons learned by Lifemasters during the
short life of the project. A central factor in their decision was
the unexpected medical needs of the Oklahoma project population.
These are "really, really sick patients. It takes a lot more to get
them under control." She explained that the Oklahoma population
included many patients with five or more comorbidities.
She pointed out
that the rural nature of the population led to unexpected results.
Lifemasters found that the population was significantly medically
underserved -- people had not been receiving appropriate medical
care in the past. Arranging for needed care would lead to higher
medical costs for Medicare and would prevent Lifemasters from
achieving required cost savings.
She described this
as an unintended consequence of Lifemaster's efforts -- an increase
in access to care for an underserved population improves quality,
but extends timeframes needed to save money.
Lifemasters also
found that providing service to this far-flung rural population lead
to higher than anticipated program costs.
Some of the other
lessons learned included:
- There is a
genuine need for disease management (DM) services in this
population.
- There is a
greater than usual need for robust, accurate, timely and complete
data.
- Once understood,
the DM services were embraced by beneficiaries, families and
caregivers. However, getting patients to understand the DM
program took more time and effort than expected.
- Patient
engagement levels need to be higher than in a commercial Medicare
Advantage population.
- There is a high
need to develop local infrastructure and support, especially with
physicians.
- The
interventions need to be far deeper -- interventions should have a
geriatric focus and must address comorbidities, mental health
issues (especially depression), case management needs, and end of
life care.
Selecky questioned
whether the rigors of Medicare's requirements for conducting a
scientific study might be incompatible with the current DM business
model. She cited the need to evaluate patient needs constantly and
to modify program elements in real time.
She briefly also
touched on Lifemaster's Florida Medicare project. She said that this
urban project was going well and wasn't experiencing the same
difficulties encountered in Oklahoma.
Commentary
This is not good
news for the DM community.
Those of you who
know me understand that I'm an advocate for DM -- a true believer.
Our health system needs to change dramatically to meet the needs of
people with chronic diseases and conditions; making this happen is
both the right thing to do and a great business opportunity.
Lifemaster's
announcement comes shortly after Healthways'
announcement that they did not achieve first year targets with
their MHS project.
Here's the central
question: Are the factors precipitating Lifemasters program
termination unique to the Oklahoma program? Or are these factors
that you would expect to see across the remaining seven MHS
programs?
Several other of
the MHS projects are being carried out in rural areas that
presumably are medically underserved and inefficient for program
delivery.
I'm still left
pondering questions about the basic design of the MHS demos:
- Is focusing on
the highest cost, frail elderly patients a realistic way to
experiment with DM in Medicare?
- Can DM companies
develop cost-effective programs and infrastructure to engage and
serve the sickest-of-the-sick Medicare patients?
- Is the goal of
randomized control trials realistic?
- Is the timeframe
for expected ROI achievable?
We knew going in
that these projects would be difficult. This news is a
confirmation.
Let me be
clear....I'm asking hard questions, not trying to predict the demise
of other MHS projects...but these are questions that need to be
asked.
Vince Kuraitis
Principal
Better
Health Technologies, LLC
E-CareManagement News is a
complimentary e-newsletter
courtesy of Better Health Technologies, LLC <http://www.bhtinfo.com/>.
For business and clinical decision
makers who are developing innovative approaches to managing chronic
diseases and conditions, Better Health Technologies is an eHealth and disease
management consulting company that can assist you with
strategy/business planning, finding
customers, and developing key partnerships.
Disclosure --
no clients are
mentioned in this issue.
You may copy, reprint or forward all
or part of this newsletter to friends, colleagues or customers, as
long as the use is not for resale or profit and the following
copyright notice is included intact. Copyright © 2006, Better Health
Technologies, LLC. All rights reserved
Comments? Write or call Vince
Kuraitis at vincek@bhtinfo.com,
(208) 395-1197 |
