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CMS demonstration targets younger seniors

Five demonstration projects are accepting participants in a three-year program to gauge whether preventive services reduce costs and chronic disease among younger Medicare beneficiaries.

CMS’ Senior Risk Reduction Demonstration (SRRD) is quite different from the Medicare Health Support (MHS) project, which will end this year after CMS officials reported disappointing cost savings.

Although MHS dealt with the sickest diabetes and CHF patients, SRRD is slated to focus on younger seniors, aged 67– 74, across multiple risks.

“This is a much wider net in terms of the population we’re working with because it’s a national random sample of beneficiaries. While there may be some participants with multiple chronic conditions, this service provides a lighter touch, focusing on self-management rather than traditional disease management,” says Julia Portale, senior director of Pfizer Health Solutions, Inc., in New York City. Pfizer is one of two companies to take part in MHS and SRRD (Health Dialog is the other).

“[SRRD is] trying to understand how people can take care of themselves and be as effective as they can managing their health,” she says.

The demonstration’s goal is to see whether health promotion, health management, and disease prevention programs that have been developed in the private sector can work within the Medicare population to achieve high participation rates, receive positive reviews from beneficiaries, reduce health risk factors, improve beneficiaries’ health, and save money for Medicare.

According to CMS, SRRD is “based on evidence that CMS gathered as part of its Healthy Aging Project, which showed that effective risk reduction programs, beginning with the administration of a Health Risk Appraisal (HRA) and including evidence-based and tailored behavior change follow-up interventions, exert a beneficial effect on behavioral, physiological, and general health status outcomes.”

“I think what is interesting about it is that it is a lighter touch than traditional disease management, so it’s really about focusing on people’s ability to change their lifestyle to maximize their health,” says Portale.

Including Pfizer Health Solutions, the five organizations taking part in SRRD are:

  • Health Dialog Services Corp. in Boston
  • Focused Health Solutions in Deerfield, IL
  • HealthPartners Health Behavior Group in Bloomington, MN
  • StayWell Health Management in St. Paul, MN

Don Hawley, chief strategy officer at Health Dialog, says his company was interested in taking part in SRRD because it dovetails with its Medicare and healthy living programs. “We basically have taken the programming that we already provide to the substantial number of Medicare beneficiaries in our current program and adapted it into the shape that the demonstration requires.”

In the SRRD project, Pfizer will work with Green Ribbon Health (created by Pfizer and Humana to provide programs in the MHS program), which will handle the social work for more intense participants, Health Fitness Corporation, which will provide health coaching, and two Aging and Disability Resource Centers, which offer social services and financial counseling.

The centers were originally created to provide a one-stop shop to help consumers make decisions regarding long-term care options and have now expanded to provide information and assistance, including Medicare Part D and health promotion programs. Portale says having the local organizations on board combines the agencies’ more personal connections with a large scale, lighter touch. 

Portale says Pfizer’s demonstration project will incorporate the company’s existing experience in health promotion into the new programs, including experience from its employee wellness program, Healthy Pfizer. She says the demonstration will be an opportunity to analyze what works and whether chronic disease self-management strategies are effective across multiple disease states in a light-touch model.

Hawley says it’s best to track the entire population rather than placing beneficiaries into disease-state silos. “As health needs change, we want to support [members] as they migrate from one segment to the next. It’s those moments of transition and change that are the most ripe for intervention and readiness for support. Our entire design and our whole program is around support, across the whole continuum. This is something we endorse.” Portale says Pfizer saw SRRD as a way to expand services across all levels of health. Pfizer has offered traditional DM programs and end-of-life services, and SRRD is a way to see whether the New York-based company can reach Medicare beneficiaries to slow disease progression and reduce costs. “It is an area that we have interest in and think it is the wave of the future in terms of being able to reduce costs and improve health,” says Portale.

Pfizer’s HRA will “determine participants’ risk for disease and will create tailored interventions to start improving participants’ health.” With that information, Pfizer will connect beneficiaries in the standard and enhanced intervention arms of the project to proper health coaching and community resources, encourage increased engagement with doctors, and promote adherence to physicians’ treatment plans.

Portale says DM companies can effectively reach out to senior populations. Pfizer learned that even the sickest individuals can change their health with the right tools. “It was rewarding to see those changes in people with multiple health issues, and we thought SRRD would be a good opportunity to try to get people on the front end to prevent some of those conditions,” says Portale.

Unlike other demonstrations that focus on a specific disease state or geographical area, SRRD cuts across health status and location. For example, the pilot phase of the program has participants in 47 states, Portale says. Hawley says CMS will compare participants with ones from more densely populated areas to see whether beneficiaries benefit from living in areas with more resources.

Capitation fee

Medicare will assign approximately 15,000–17,000 randomly selected beneficiaries to each vendor for recruitment into the demonstration. About 85,000 fee-for-service Medicare beneficiaries will take part in the project.

CMS will pay the five organizations on a monthly per-beneficiary capitation fee with the understanding that each company must accept a 10% withholding of its fee each year of the demonstration and as much as 15% during the course of the demonstration. The organizations must reach budget neutrality.

Hawley says Health Dialog has designed a program that will at least reach that goal. “It’s hard in a three-year trial, when a lot of the population is healthy, to be able to see the payoff of healthy living support, because a lot of that stuff gets deferred beyond the scope of the study. I think the value of these kinds of work will have a tail on it that will go beyond the scope of the study,” he says.

Health risk categories in SRRD project

The Senior Risk Reduction Demonstration (SRRD) will address the following health risk categories simultaneously:

  • Physical inactivity/lack of exercise
  • Poor nutrition
  • Smoking/tobacco use
  • Excessive tobacco use
  • Excessive alcohol consumption
  • High BP
  • High blood glucose levels
  • High total cholesterol
  • Overweight/obese
  • Inappropriate use of clinical preventive services
  • Depression
  • High stress
  • Lack of general well-being
  • Burden of providing caregiving
  • Social isolation
  • Lack of motor vehicle/home safety
  • Falls (preventable accidents)
  • Polypharmacy/medication issues

Source: Senior Risk Reduction Demonstration vendor solicitation notice.