LifeMasters and Health Network One are implementing a financial incentive component to their South Florida Medicaid and Medicare demonstration project.
LifeMasters is testing the hypothesis that beneficiaries’ health will improve if physicians have a vested interest in their patients’ long-term engagement, said CEO Christobel Selecky.
“We have found that the longer somebody is in the program, their clinical outcomes improve,” she said.
The demonstration, begun in 2005 and redesigned in 2007, provides services to dual-eligible Medicare fee-for-service beneficiaries with congestive heart failure (CHF) and any combination of CHF, coronary heart disease or diabetes.
Thus far, HN1 has received “extremely positive” responses from its physicians, said Charles Wilhelm, MD, CMO of Health System One, an HN1-owned network.
The enthusiasm is driven by the belief that this program will produced increased quality of care for their patients, he said. The physicians also acknowledge the benefits of being paid for the extra time spent on their patients, having their input help structure the program and being provided with clinical and outcomes data related to quality, which will help identify gaps in care, he said.
“The objective of the demonstration is to test whether disease management in the traditional fee-for-service program leads to improved outcomes and lower total costs to the Medicare program,” said Peter Ashkenaz, spokesman for the Centers for Medicare and Medicaid Services.
CMS extended the project to year four in January 2009. “We will know at about this time next year if the demonstration has been extended,” he said.
“We directly attribute the success of this demonstration program to the collaboration between CMS and LifeMasters,” Selecky said.
Disease management was looked at as the “silver bullet,” she said. In reality, it’s still in the research and development stage of enhancing and measuring different systems, tool and approaches, she said.
“We all passionately believe that the patient is a great unharnessed resource,” Selecky said. “Both the patient and the physician are critically important parts of this program.”