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Medicare AdvantageMedicare Advantage Plans Improve Diabetes Care and Lower Costs Reprinted from the Oct. 26, 2006, issue of MEDICARE ADVANTAGE NEWS, biweekly news and analysis on the Medicare (and Medicaid) managed care programs. After three-and-a-half years of fine-tuning a program that offers financial rewards to physicians for good systems of care to diabetic members, Independent Health Plan says it is starting to see results. The Buffalo, N.Y.-based plan cites steadily declining costs from fewer hospitalizations and emergency department visits, and tells AIS that some of the best results are occurring among its Medicare Advantage (MA) members with diabetes. "We cannot tease out the impact of our [diabetes pay-for-performance] program from our other disease management activities in diabetes, so the only financial data we have bundles all of our program expenses versus the total medical savings related to diabetes on the population," says Thomas Foels, M.D., Independent Health's medical director. "Based on this type of analysis, we are currently seeing a 1 to 2.48 return on investment (ROI) on all lines of business, and a much higher ROI of 1 to 11.4 when the Medicare line is separated out." Foels estimates that the program has yielded $8.8 million in savings for its Medicare population alone for the one-year 2004-2005 period. On Sept. 28 the Alliance of Community Health Plans released a report concluding that overall MA plans improved care for members on each of the HEDIS performance measures for diabetes between 2002 and 2005. Independent Health is among ACHP's 13 member managed care organizations. The report found that MA plans performing well on a particular performance measure, such as regular eye exams for diabetic patients, tended to score highly on other measures. Conversely, plans performing poorly in one area tended to perform poorly on other measures. "The systematic nature of highly performance seen in the data tells us that high performance is not random. High-performing plans invest in the systems needed to provide quality care," ACHP President and CEO Jack Ebeler stated in issuing the report. The report concludes that while performance measurement and reporting have helped to improve diabetes care among MA plans, they have not closed the quality gap. Ebeler asserts that Medicare, by paying high- and low-quality MA plans in the same manner, fails to recognize investments in quality or to hold low-performing plans accountable. Alliance Pushes Aligning Payment With Quality The alliance maintains that retooling the MA plan payment system in a way that aligns federal payment with quality would help improve care to Medicare beneficiaries. According to Foels, Independent Health decided to move beyond single performance measures and developed a composite scoring system for diabetes based on clinical practice guidelines in western New York. With the help of a physician advisory panel, the nonprofit plan created a medical record review for patients identified as diabetic from claims records and who had already been seen in a physician's office. Foels cites three components to a successful pay-for-performance program: physician reporting and profiling; linking good performance to financial compensation, which he describes as requiring "adequate compensation to get a physician's attention;" and helping physicians understand their performance reports and what other medical practices are doing to achieve systematic improvements. An estimated 400 medical practices (most of them solo or small group) are participating in Independent Health's pay-for-performance program for diabetic members, Foels says. While the incidence of Type II diabetes is around 6% in the general population, he says, the incidence is closer to 20% in the plan's Medicare population. Independent Health, which launched its first Medicare managed care product a decade ago, has about 38,000 MA members, along with 30,000 Medicaid members and 260,000 commercial members. "We currently have about 7,500 MA diabetic members on the radar screen for this [diabetes] program. They're in the [medical records] sample we pull from" in sending reports to physicians, he explains. The report is found at http://www.achp.org/library/download.asp?id=6819. |
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