Panel: Medicare Demo Program survivors share success stories

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Representatives of two of the three data and disease management Medicare Demonstration Programs that did not get cancelled discussed their programs' success strategies at the sixth annual Connected Health Symposium last week in Boston.

Moderator Gregg S. Meyer, MD, senior vice president for the Edward P. Lawrence Center for Quality and Safety at Massachusetts General Hospital (MGH) and Massachusetts General Physicians Organization, began the panel noting that, generally, 5 percent of healthcare professionals use the vast majority of healthcare resources. Meyer stated this current model cannot support itself with the majority of resources going to a small percentage of professionals.

Eric Weil, MD, medical director of the care management program at MGH, and Suneel Ratan, vice president of marketing and reimbursement at Robert Bosch Healthcare in Palo Alto, Calif., sat with the Director of the Medicare Demonstrations Group at the Centers for Medicare & Medicaid Services (CMS) Linda Magno, to discuss why their programs “had not been terminated,” according to Ratan, and what steps are needed for future disease management development.

Ratan and Weil’s programs, Meyer said, helped exemplify the possibility of a sustainable Medicare system. Their programs are two of three CMS data and disease management demonstrations that have not yet been terminated. In fact, both programs are expanding their efforts into larger populations.

Weil’s program at MGH is modeled after a practice-based care manager system--it redesigns the caregiver to be more embedded in the practice by following the patient longitudinally. This, Weil noted, offers the physician the opportunity to be a patient’s partner and opens the patient to additional--but not redundant--points of access to their care.

MGH created an infrastructure to support efficiency by including health IT, so the case manager receives notifications for a patient’s various endeavors--including when they are in an emergency department, miss an appointment or schedule urgent appointments--so the physician can intervene at key moments.

Entering into its second year, the program is expanding into another hospital, Weil said.

Ratan said his program was largely reliant on home monitoring systems for patients with a wide range of chronic conditions in two sites in Washington and Oregon. He stated that its benefits are self-management for the beneficiary and early detection of exacerbating conditions for the physician.

Magno stated, however, that no program is ready to be a national solution for disease management. One challenge, she said, will be to move demonstrations into a protocol using specific measurements for evaluation purposes. It remains to be seen if Ratan and Weil's initial successes are specific to their populations or not.

Weil cited that programs must identify the right population, engage the population and have effective intervention to be successful at any level.

Magno said that targeting will also be important to the ongoing move toward a protocol. "You can’t spend too much time and energy on one initiative," she said, citing the recent interest in obesity initiatives. “We still have a lot to learn about changing behaviors. Targeting is important with how we use our resources. You can’t spend all of your resources on narrow slices."