A recent NY Times Economix blog post by Professor Uwe E. Reinhardt, Comparing the Quality of Care in Medicare Options, notes the lack of good research available to evaluate whether there is a difference in the quality of care provided by Medicare Advantage (MA) plans vs. traditional Medicare. He goes on to say that given the evidence that is out there, he leans toward giving the MA plans the edge. HQP’s experience in this regard is still evolving, but may be instructive, and seems to be in accord with Dr. Reinhardt’s tentative conclusion.
HQP’s journey to develop an innovative new delivery model to improve the health of vulnerable populations began over 12 years ago. The basic idea was simple. Find a way to more effectively prevent complications among the chronically ill. How? Develop a robust bundle of preventive services matched to the needs of a target population then deliver it in a highly reliable, individually-customized way through a proactive, engaging, supportive, accessible, and ongoing service. We call the program developed using this disciplined approach to design and implementation, an Advanced Preventive ServiceSM model of care.
HQP’s journey to develop an innovative new delivery model to improve the health of vulnerable populations began over 12 years ago. The basic idea was simple. Find a way to more effectively prevent complications among the chronically ill. How? Develop a robust bundle of preventive services matched to the needs of a target population then deliver it in a highly reliable, individually-customized way through a proactive, engaging, supportive, accessible, and ongoing service. We call the program developed using this disciplined approach to design and implementation, an Advanced Preventive ServiceSM model of care.
The HQP team has had the extraordinary opportunity to test its Advanced Preventive Service program in the Medicare Coordinated Care Demonstration (MCCD). This taxpayer funded demonstration was enacted by Congress in the Balanced Budget Act of 1997. In effect, Congress told CMS to try something new to improve quality and lower cost and, in this case, also specified what kind of program they should try. CMS eventually launched the demonstration in 2002. Fast forward 11 years, to today.
The Advanced Preventive Service program has proven to be a breakthrough in health services delivery. It lowers cost, reduces hospitalizations, and improves the health outcomes and experience of care for a complex, expensive, and rapidly growing segment of our population – chronically ill older adults. After many years of rigorous testing, using the gold-standard of a randomized clinical trial analyzed on an intention to treat basis, our results have been published in multiple Reports to Congress, peer-reviewed journals, and presented at national conferences. A summary slide of these results is available (click here) and you can link to the full article published in PLoS Medicine describing how our Advanced Preventive Service program lowered all-cause mortality 25% (click here).
Amazing right? This new innovation can make a significant contribution to transforming our current system from a sick care model that flounders to serve an aging, increasingly chronically ill population to one designed for the modern era – more preventive and more effecitve at addressing the root causes of illness and suffering. So which payers will make this breakthrough program available to those who can benefit? CMS who tested and proved its value? Or MA plans?
CMS has indicated to HQP that it plans to terminate the MCCD at the end of June 2013, but has not provided any indication about how or whether CMS plans to make the Advanced Preventive Service program available to eligible beneficiaries in traditional Medicare. The apparent lack of urgency by CMS in this regard is perplexing in light of the cost savings and better outcomes for higher-risk beneficiaries associated with the program, the crisis of Medicare solvency and quality, the ballooning national debt, and the authority available to the Secretary of HHS to adopt new innovations that really work. At the very least, HQP hopes to be granted access to data collected during the demonstration so that HQP can advance the research needed to further innovate and improve this model. Unfortunately all such requests of CMS have so far gone – unanswered. Meanwhile, Aetna, on the basis of HQP's MCCD results, has already been providing HQP's Advanced Preventive Service program to its high-risk Medicare Advantage members for more than 2 years; click here to see Aetna’s most recent press release.
Reinhardt notes that what passes for evidence when comparing quality in Medicare Advantage plans vs. traditional Medicare, is largely anecdotal – story-based. At this point in the unfolding story of HQP’s pioneering work and Medicare's evolution, whether CMS will be able to harness proven innovations that improve the quality of care to traditional Medicare beneficiaries remains a mystery. Millions of Americans are counting on them to do so. Their decisions will do much to shape the next chapter in that story.
Advanced Preventive Service is a service mark of Health Quality Partners for its line of highly-effective preventive health programs.
The Advanced Preventive Service program has proven to be a breakthrough in health services delivery. It lowers cost, reduces hospitalizations, and improves the health outcomes and experience of care for a complex, expensive, and rapidly growing segment of our population – chronically ill older adults. After many years of rigorous testing, using the gold-standard of a randomized clinical trial analyzed on an intention to treat basis, our results have been published in multiple Reports to Congress, peer-reviewed journals, and presented at national conferences. A summary slide of these results is available (click here) and you can link to the full article published in PLoS Medicine describing how our Advanced Preventive Service program lowered all-cause mortality 25% (click here).
Amazing right? This new innovation can make a significant contribution to transforming our current system from a sick care model that flounders to serve an aging, increasingly chronically ill population to one designed for the modern era – more preventive and more effecitve at addressing the root causes of illness and suffering. So which payers will make this breakthrough program available to those who can benefit? CMS who tested and proved its value? Or MA plans?
CMS has indicated to HQP that it plans to terminate the MCCD at the end of June 2013, but has not provided any indication about how or whether CMS plans to make the Advanced Preventive Service program available to eligible beneficiaries in traditional Medicare. The apparent lack of urgency by CMS in this regard is perplexing in light of the cost savings and better outcomes for higher-risk beneficiaries associated with the program, the crisis of Medicare solvency and quality, the ballooning national debt, and the authority available to the Secretary of HHS to adopt new innovations that really work. At the very least, HQP hopes to be granted access to data collected during the demonstration so that HQP can advance the research needed to further innovate and improve this model. Unfortunately all such requests of CMS have so far gone – unanswered. Meanwhile, Aetna, on the basis of HQP's MCCD results, has already been providing HQP's Advanced Preventive Service program to its high-risk Medicare Advantage members for more than 2 years; click here to see Aetna’s most recent press release.
Reinhardt notes that what passes for evidence when comparing quality in Medicare Advantage plans vs. traditional Medicare, is largely anecdotal – story-based. At this point in the unfolding story of HQP’s pioneering work and Medicare's evolution, whether CMS will be able to harness proven innovations that improve the quality of care to traditional Medicare beneficiaries remains a mystery. Millions of Americans are counting on them to do so. Their decisions will do much to shape the next chapter in that story.
Advanced Preventive Service is a service mark of Health Quality Partners for its line of highly-effective preventive health programs.