HCPro.com: Disease Management Advisor

July 2008 (Volume 14, Issue 7)	view entire issue

Medical home payment structure offered
The advanced medical home concept has been praised by health plans, physicians, and DMAA: The Care Continuum Alliance, which has voiced its support for the concept. The overall theory of putting a patient's care coordination into the hands of the provider has caught on despite the fact that the shape and breadth of the advanced medical home model remains in question. What kind of role will DM play? Will DM vendors offer complementary services for providers rather than health plans? And, perhaps most importantly, what do you pay providers for overseeing care coordination?

Medicare Health Support program nearing its close
CMS' announcement that it was ending the Medicare Health Support (MHS) demonstration project caused a spasm of criticism from the DM industry earlier this year. Despite the efforts of high-powered legislators who requested an extension to the MHS program, CMS still plans to end the project this year. The project began in 2005 as a way to test DM programs in the Medicare population in the areas of HF and diabetes. MHS has traveled a rocky road in the past three years, with three of the eight awardees (LifeMasters Supported SelfCare, McKesson Health Solutions, and CIGNA) dropping out of the project.

New marketing regulations proposed for SNPs
CMS has proposed new regulations in hopes of protecting beneficiaries enrolled in Medicare Advantage (MA) and special needs plans (SNP). The proposed plan would prohibit cold calling and expand the current prohibition on door-to-door solicitations, prohibit sales activities at educational events, require state-licensed agents for MA organizations that use independent agents to market MA and Part D plans, and require MA organizations to use commission structures for agents and brokers.

Study says heart failure program too costly
A telephonic DM program for HF patients in South Central Texas was not cost-effective, but the study's authors say the program could have saved money if it had been targeted to the right patients. Published in the February Academy Journal of Managed Care, the study, "Cost-Effectiveness of Telephonic Disease Management in Heart Failure," was "one of the first studies to assess the cost-effectiveness of DM in HF in a large sample with a follow-up period exceeding 12 months," wrote the authors.

Five questions with . Mack Bryson
Disease Management Advisor is kicking off a new feature, "Five questions with ... " this month. In each issue, we'll profile an industry leader to get his or her thoughts on the leading issues in DM and population health. This month, we feature Mack Bryson, CEO of HealthScreen Disease Management in Jacksonville, FL. In 2007, HealthScreen moved from the traditional regional market to a national model. Bryson talks about those experiences and what it takes to go national.

Other recently-published articles from Disease Management Advisor:

Weight loss helps type 2 diabetes patients

Physician practices will need DM/population health

College announces chronic care degree program

VillageHealth pleased with ESRD program

MTM program increased statin use

CMS trumpets PGP demonstration successes

Five questions with . Keith R. Dunleavy, MD

Bringing programs together improves results

Care management shows benefits

Study affirms connection between diabetes, depression

Playing to good health

Five questions with . Mack Bryson

Study says heart failure program too costly

New marketing regulations proposed for SNPs

Medicare Health Support program nearing its close

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