Health for life

The Disease Management Care Blog finally caught up with it. 

Heres its take:

Its a well-written and traditionally crafted summary of CMS six demonstrations that had the participation of 34 programs:

Care Management for High Cost Beneficiaries
Medicare Coordinated Care
Disease Management for Dual Eligibles
Informatics for Diabetes Education and Telemedicine
Disease Management for Severely Chronically Ill Beneficiaries
Medicare Health Support

Why Demos?

Demos are used by CMS to test innovative care strategies before they are formally adopted as a covered benefit in the fee-for-service program. These demos were funded because CMS knows that half of all Medicare beneficiaries have five or more chronic conditions and that they account for 75% of its costs. In addition, up to 50% of beneficiaries are not receiving recommended care, such as vaccinations and cancer screening.

How Did the Demos Work?

The programs enrolled persons with a variety of chronic conditions such as diabetes and heart failure. Kick off dates ranged from 2000 to 2005. "Hierarchical condition categories" or high baseline expenditures were used to identify and target the persons at high risk. All used care coordination nurses who were typically - but not always - remote and disconnected from the physicians. There was little information on admission criteria to the programs, on the training or credentials of the care managers, the approaches used in to manage transitions across care settings or improving medication compliance.

What Was the Bottom Line?

On average, the programs were unable to achieve savings in excess of Medicares fees.

The programs reduced hospitalizations by an average of 7%. In order for Medicare to have saved money based on the disease management fees, the hospitalizations would have had to be reduced by 11%. Programs that involved greater in-person interactions between nurses and patients appeared to have greater success in reducing admissions rates.

The evaluation was also statistically stymied by relatively low numbers of patients in some of the programs. It is possible that there were savings, but if they exist, they were too small to be detected by widely accepted statistical methods.

So What DMCB Conclusions Can Be Drawn and Why?

There are two:

1.The "versions" of disease management used by Medicare from 2000-2005 relied on approaches used in commercial settings from 1995-2000. These deployed remotely stationed nurses calling patients with worrisome cost patterns. From 2000-2005, commercial insurers and employers knew that wasnt working and transitioned to more sophisticated engagement protocols as well as in-person care programs tailored for patients with high as well as modifiable risk.

In other words, the impact of later versions - like this, this and this - of disease management in fee-for-service Medicare remains largely unknown. Thats why the CBO report ends with the conclusion that....

"...the demonstration results indicate that additional experimentation, evaluation, and inement over a period of years will probably be needed to identify policies involving disease management and care coordination that can significantly reduce Medicare expenditures."

Of course, by the time CMS gets done with more years of "experiments," "evaluation" and "inement," those results will likewise be obsolete.

2. This begs the question: if Medicare cant achieve savings, why do practically all insurers and most self-insured employers still include disease management programs in their benefit designs?

The DMCB suggests that in addition to a growing body of peer-reviewed literature showing that more modern (and still untested by Medicare) disease management is "efficacious," non-governmental insurers have some additional advantages that increase real world effectiveness:

1.Using disease management as only one component in an overlapping suite of other mutually supportive programs, including consumer-based incentives to rely on primary care, value-based insurance designs, intelligently restricted networks and concurrent wellness and prevention programs.

2. Access to internal assessments of program success that will never be submitted for publication in the peer reviewed literature.

3. Flexible program adaptation to the myriad local cultural and community factors that determine success. After all, what works in a motorcycle factory in the Midwest may not work in a cubicle farm in Silicon Valley.

The DMCB Bottom Line:

While the CBO report is technically correct, it promotes the tired canard is that modern disease management consists of naive nurses making blind calls and exhorting baffled consumers to take better care of themselves. In addition, the idea that single standard can be implemented everywhere in a stand-alone fashion is a pipe dream. No wonder Medicares disease management demos have failed.

The Feds need to figure out how to implement disease management, not what doesnt work.

Sweet readers, I have to apologize in advance for what might be a spotty couple of weeks. The wedding is approaching at lightning speed, work has picked up, and to top it off, we adopted Tim Riggins four days ago.

No, not this Tim Riggins.

This Tim Riggins.


 Last week, Tim was the friendliest young stray cat Husband-Elect and I had ever met. This week, after searching for any sign of local ownership and coming up with zilch, he is our pet. We’ve already been to the vet for a checkup and several shots, and are scheduled for a de-cojone session on Friday.

Here’s the thing: I don’t know the first thing about felines. I’ve never owned one, and don’t even particularly like them. Tim, however, seems to be the exception. It could be his constant purring and general adorability, or the fact that he has not yet peed on my pillows. (Husband-Elect, having had a cat growing up, is slightly more knowledgeable.)

Subsequently, I will have a recipe for you tomorrow, but in the meantime, we’re kind of scrambling to feed this guy. Coincidentally, it leads to today’s normally-on-Tuesday Ask the Internet question:

Q: Do you own a pet? How do you budget for him/her? What do you feed your pet that allows you to optimize its health, but stay within your budget?

A: All suggestions are super welcome, though if you have a cat (or several cats), I’d really love your input. (Also – cats don’t drink milk? They’re lactose intolerant? Everything I know is wrong.)

Thanks, everybody!

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

As I write this, I’m sitting reception on our mattress with fourteen native menus to my left. The swain and that i had alimentary paste tonight (delicious, delicious spaghetti), however were pretty tempted to order takeout. we tend to do this generally, as a result of A) we tend to like food, B) we tend to sort of a selection therom, and C) dishes. (As associate degree aside, I’m convinced that dirty dishes area unit the basis explanation for ninetieth of friend fights. sign in for off-campus faculty housing and see for yourself.)

Ordering takeout happens with some frequency in our abode. It keeps U.S.A. from falling into a cookery rut and lets U.S.A. want we’re treating ourselves. However, it’s continuously a challenge to try and do thus cheaply and healthily. benny Chicken is tempting, see. thus area unit dish and pad thai and chicken parm and samosas and nachos and … Ohio man, I simply wet myself. Anyway, my budget and waist arasure} forever operating against me, and generally I even have to shun the cooked diamond-encrusted dodo eggs for one thing easier and fewer heart attacky.

With that in mind, today’s post could be a short-n-handy erence guide to ordering meals by phone. basically, it’s eight completely different, common takeout cuisines with a couple of cheap, semi-nutritionally sound foods allotted to every one. Weight Watchers, Calorie King, and Real straightforward helped give the health data, whereas the antecedently mentioned fourteen Brooklyn-area menus equipped the rating. For brevity’s sake, it concentrates on takeout solely, since eating house eating could be a whole alternative ball of noodles.

Ah, however before we start, a couple of tips about maximising your low-cost, healthy experience:

    If you order associate degree unexpectedly giant portion, place [*fr1] within the icebox as before long as youve got it. It’ll wreak a good lunch tomorrow.

 bear in mind that you just might get additional bang for your buck from some takeout joints (Chinese, Indian) than from others (Japanese). If you’re wanting to feed a crowd, the less-expensive possibility may be the higher alternative.

 to scale back value, calories, and fat all at constant time, minimize deep-fried foods and go straightforward on the meat and cheese.

 contemplate ordering appetizers solely, as they will be a lot of more cost-effective.

    If you’re involved concerning calories, fat, or sodium, check nutritionary data on-line before ordering. Calorie King could be a nice general erence, and lots of chain restaurants have the stats announce somewhere on their sites.

    Have condiments or lightweight dressings at home? Use ‘em and save packets that associate with the meal.

    If youve got an analogous item within the storeroom, don’t order beverages.

    Save the environment! Tell the phone operator you don’t would like utensils, since youve got tableware in your room.

    Tip the delivery guy. If you can’t afford to tip, you can’t afford takeout.

And now, the list! (Incidentally, i would like to increase this, thus if youve got suggestions, please bring em on.)

Chinese
Boiled wontons
Chicken, shrimp, or vegetable egg foo yung
Chinese vegetables with bean curd
Egg drop or hot and bitter soup
Fortune cookies
Steamed chicken, shrimp, or vegetables with brown or aioli on the facet
Steamed shrimp or vegetable dumplings
White or rice

Mexican
Bean dish (easy on the cheese and bitter cream)
Black bean soup
Black or horse beans
Chicken or vegetable soft taco (easy on the cheese)
Rice and beans
Salsa or pico Diamond State gallo

Thai
Chicken satay (easy on the peanut sauce)
Ginger chicken
Salads (minus peanuts, no or lightweight dressing)
Thai chicken with basil (breast)
Thai food dish
Tom yum kung (hot-and-sour shrimp soup)

Japanese
Chicken, shrimp, tofu, or vegetable soba
Chicken, shrimp, tofu, or vegetable udon
Edamame
Maki dish (in tiny quantities)
Miso soup
Nigiri dish (in tiny quantities)
Nori maki dish (in tiny quantities)
Seaweed dish
Shumai
Steamed vegetable dumplings

Greek
Baba ghanoush
Cucumber side dish
Dolma
Greek dish (no or fatless dressing)
Olives
Pita
Souvlaki (1 skewer)
Souvlaki sandwich

Middle japanese
Couscous
Cucumber side dish
Dolmas
Hummus
Lentil soup
Pita
Shish kebab (marinated meat and vegetables)
Tabbouleh (1/2 cup)
Yogurt and cucumber soup

Indian
Bean and/or lentil stew
Chicken tikka
Chicken tikka masala
Chutney
Cucumber side dish
Lassi (1 cup)
Naan
Poori (Puri)
Tandoori chicken while not skin

Italian
Baked clams
Lentil soup
Linguini with red clam sauce (1 cup alimentary paste, ½ cup sauce)
Mussels
Pasta primavera (1 cup alimentary paste, ¾ cup sauce)
Salad (no or fatless dressing)
Thin-crust pizza pie (one slice)

(Photo courtesy of msnbc.)