DMAA Hails Decision On Financial Threshold For Medicare Health Support, USA

Main Category: Medicare / Medicaid / SCHIP
Article Date: 08 Jan 2008 - 14:00 PDT

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DMAA: The Care Continuum Alliance hailed a federal decision to make budget neutrality the financial performance threshold for the developing Medicare Health Support (MHS) disease management pilot.

"This is a prudent, positive decision for Medicare Health Support Organizations and the thousands of beneficiaries they serve daily," DMAA President and CEO Tracey Moorhead said. "Moving to budget neutrality means greater stability for MHS and, ultimately, greater access to essential chronic care services for our nation's elderly."

The change to budget neutrality as the MHS financial performance threshold was approved Dec. 28, 2007. Until then, each Medicare Health Support Organization (MHSO) faced a 5 percent net savings requirement and assumed 100 percent fee risk for performance that fell short of that goal. In contrast, the authorizing statutory language approved by Congress in the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) set budget neutrality as the original financial threshold.

DMAA has maintained that the Centers for Medicare and Medicaid Services (CMS) should define budget neutrality as the financial performance threshold for the first phase of MHS, along with improvements in the non-financial metrics of clinical indicators and participant satisfaction. DMAA memorialized this position in one of a series of statements on MHS it issued in 2007 and that are available on its Web site, http://www.dmaa.org.

"We are extremely pleased to see the performance threshold brought in line with the authorizing statute," said Christopher Coloian, DMAA Government Affairs Committee chair and a CIGNA vice president. "This change will help place the focus back on improved clinical measures and beneficiary satisfaction."

DMAA believes that MHS represents a landmark opportunity to improve the quality of health care for chronically ill Medicare beneficiaries and provides a platform for efficient delivery of evidence-based medicine on a population-wide basis. "MHS represents an innovative approach toward delivery system change, outreach to chronically ill beneficiaries, cost containment and improved quality of life for beneficiaries," Moorhead said.

The Medicare Payment Advisory Commission (MedPAC), a congressional advisory body, also has recognized the potential value of population-based programs to improve quality and satisfaction and achieve long-term cost containment. In its 2006 report to Congress, MedPAC suggested that quality and outcomes improvements alone might warrant use of such programs and that cost savings might not be essential to their widespread adoption. The Commonwealth Fund, in a recent report on options for improving health care value and savings, reached a similar conclusion, saying, "Higher value includes improved performance on quality, equity, access, and healthy lives, in addition to savings."

About DMAA: The Care Continuum Alliance

DMAA: The Care Continuum Alliance convenes all stakeholders providing services along the care continuum toward the goal of population health improvement. These care continuum services include strategies such as health and wellness promotion, disease management, and care coordination. DMAA: The Care Continuum Alliance promotes the role of population health improvement in raising the quality of care, improving health outcomes and reducing preventable health care costs for individuals with chronic conditions and those at risk for developing chronic conditions. DMAA's activities in support of these efforts include advocacy, research and the promotion of best practices in care management.

DMAA: The Care Continuum Alliance represents more than 200 corporate and individual stakeholders--including wellness, disease and care management organizations, pharmaceutical manufacturers and benefit managers, health information technology innovators, biotechnology innovators, employers, physicians, nurses and other health care professionals, and researchers and academicians.

DMAA: The Care Continuum Alliance