DM Megatrends

November 7, 2006


Filed under: Commentary — by bhtinfo @ 11:41 pm

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 MHS project. She said that this urban project was going well and wasn’t experiencing the same difficulties encountered in Oklahoma.


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
Better Health Technologies, LLC

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