Wednesday, September 14, 2011

Lowering Costs Urgent

Donald M. Berwick MD, Administrator, for CMS kicked off the Health Affairs event on September 8th to present their September issue with studies focused on the urgency to lower costs. Berwick best described the CMS approach to reducing costs by using the term “Triple Aim” which refers to better care for individuals, better health for populations, and attaining lower per capita costs without doing any harm to patients.

Berwick talked about the steps that CMS has taken so far. For example, CMS recently launched the ‘Partnership for Patients” an initiative that is going to make an unprecedented investment to support physicians and other health professionals reduce injuries and help avoid hospital readmissions.

Also, to keep more people healthy, the Affordable Care Act (ACA) provides for a free annual wellness visit to enable physicians and patients to develop and update a personalized prevention plan to help Medicare beneficiaries remain healthy. So far this year, over 18.9 million people enrolled in traditional Medicare have used preventive services with no cost to them. Many of these services will help prevent chronic diseases that can cost Medicare billions to treat.

As Berwick mentioned, CMS has been actively trying to lower prescription drug costs. The ACA will phase out the Medicare Part D coverage gap or donut hole for Medicare Beneficiaries by 2020. This year, people on Medicare who do not already receive low-income subsidies will receive approximately a 50 percent discount on covered brand name prescription drugs and biologics while they are in the donut hole. So far, nearly 1.3 million people have received savings on their brand name prescriptions drugs when they hit the donut hole.

Also, this year, the CMS Innovation Center started a new demonstration program called the “Community Based Care Transition Program” to reduce hospital readmissions, test sustainable funding streams for care transition services, maintain or improve quality of care, and document measureable savings for the Medicare Program.

CMS is successfully addressing the issue of fraud to reduce costs. Berwick announced that the Joint Department of Justice-HHS Medicare Fraud Strike Force operating in eight cities has resulted in charges being made against 91 defendants including doctors, nurses, and other medical professionals for their alleged participation in Medicare fraud schemes. The loss due to fraud from the 91 defendants involved would have resulted in about $295 million in false billing.

Another study in the September issue stresses that CMS can further produce savings by integrating telehealth to help Medicare beneficiaries manage chronic diseases. This according to a study by Laurence C. Baker, Professor of Health Research and Policy at Stanford University and his colleagues Scott J. Johnson, Dendy Macaulay, and Howard Birnbaum. The team studied the CMS “Management for High Cost Medicare Beneficiaries Demonstration” to see where it succeeded and failed. The demonstration used the Health Buddy System a telehealth device to integrate care management in treating chronic diseases.

As Baker explained, the demonstration was initiated to see if Medicare beneficiaries with chronic diseases if managed more efficiently could produce savings. The demonstration began in 2006 and used in two clinics in Washington and Oregon, targeted traditional Medicare recipients with CHF, COPD, or diabetes mellitus. The treatment group members were identified and invited to join and if they did accept, they received a free telehealth device as they entered the program.

The team found significant savings among patients who used the Health Buddy telehealth program. Their conclusion based on the results from the demonstration, suggest that carefully designed and implemented care management and telehealth programs can help reduce healthcare spending and such programs should be considered by Medicare.

Another study in the September Health Affairs issue shows how a weight loss program for pre-diabetic adults 60-64 could save Medicare billions. The program implemented in partnership with YMCAs across the country is offering help with the very real problems of weight gain that leads to diabetes, high cholesterol, and high blood pressure.

Under the plan included in the study, the study’s lead author Kenneth E. Thorpe, a Professor at the Rollins School of Public Health at Emory University reports that “Most of the growth in healthcare spending is linked to rising rates of diabetes, high cholesterol, and high blood pressure.”

Under the program, a trained lifestyle coach helps overweight people eat healthier food and increase their physical activity. Studies of the program and others like it have found that participants age 60 and older lose weight and reduce the risk of developing diabetes and other health-related problems by up to 71 percent.

The study’s authors estimate that the program would cost the federal government $590 million and proposed that CDC’s National Diabetes Prevention Program and the Prevention and Public Health Trust Fund provide funding. The authors think that the investment would eventually end up saving Medicare an estimated $3.7 billion over the next 10 years or by $15.1 billion in net lifetime savings if the occurrence of diabetes, high cholesterol and blood pressure were reduced.

The information appearing in the September issues can be found at or on Facebook and Twitter.