|CMS, MA Plans & Disease Management?|
Using the Care Continuum Alliance's definition of PHM, researchers from America's Health Insurance Plans (AHIP) and Brandeis University conducted a written and then telephonic survey of 42 out of 72 larger Medicare Advantage (MA) Plans. While the results were interesting, what caught the Disease Management Care Blog's eye was that.....
Disease and case management are "routinely used." These programs are made up of nurse hotlines, telephone visits, increasing access to social services, meeting patients' psychosocial and providing care coordination. An accompanying infographic says "100%" offer "teaching chronic disease self-management."
Health risk assessments are also used "universally" and target self-identified individuals with outreach designed to educate and/or enroll in programs that reduce risk factors.
Care managers for the frail elderly are available in "100%" of plans. A second infographic points out that home safety, in-home visits and community services referrals are among the top used interventions. And, as testimony to a lingering sense of skepticism over remote home monitoring, the infographic says that was only used in 56% of plans.
Unlike Medicare fee-for-service (FFS), hospital readmissions have been a top concern of the MA Plans for years. They know there is no single "silver bullet" and have long relied on a combination of nursing, social services, home-health visits, medication reconciliations, follow-up care coordination programs and home visits. Survey respondents were convinced their programs were "effective."
In other examples of MA Plans being light-years ahead of Medicare FFS, if providers need data, MA Plans will make it available. If payment reform is necessary, MA Plans will make deals involving global risk arrangements, bundled payments and shared savings.
Evidence? Regretfully, say the authors, there is a lack of "systematic evidence" supporting PHM's effectiveness. They also believe that there is conflicting evidence on whether MA Plans achieve better outcomes versus Medicare FFS.
The Disease Management Care Blog's take:
While skeptics continue to believe that Medicare Health Support "proved" that "disease management" doesn't work, the MA Plans correctly surmised that MHS only proved that early versions of disease management in Medicare FFS settings doesn't work. The MA Plans have figured out how to improve on disease management.
While published data may be lacking, the people who run MA Plans are not dunces. They have internal data showing that it works, or they wouldn't be using it.
While the Medicare Advantage program is controversial, the Health Affairs post suggests the MA Plans are useful laboratories for seeing what can be of benefit in the care of Medicare-eligible seniors. If ACOs flop, perhaps CMS will go back to the future with their MA Program for ideas on what can work.