Pfizer Health Solutions, Florida: A Healthy State & more on Open Source

In the last two Disease Management Care Blog (DMCB) entries, we impertinently suggested the industry jettison the short-term competitive advantage of their clinical/claims data bases and adopt an Open Source “business model.” The chief advantages are 1) increased credibility, thanks to inviting independent confirmation of any conclusions, 2) the likelihood of new discoveries, thanks to more scientists (and eventually amateur-scientist lay persons) “mining” the data and 3) achieving the fullest manifestation of what Kaiser Permanente is teaching us: that the advent of these colossal patient/enrollee/consumer data bases in the disease management industry are an incredibly valuable resource that exceeds the biggest baddest electronic health record. The potential benefit to the general knowledge of mankind is great. So, by the way, is the good will it would generate.

For a good example, first congratulate the folks at Pfizer Health Solutions (PHS) for getting some important clinical outcomes into the peer review literature. Most readers of the DMCB will recall PHS is providing disease management services to portions of the Florida Medicaid population. PHS funded a study on the impact of their “Florida: A Health State” Program on a number of outcomes including blood pressure, lipids, blood glucose and asthma control among persons with chronic illness who were enrolled in their program. Morisky and colleagues at the UCLA School of Public Health found there was a clinically and statistically significant improvement across multiple care domains.

The improvement was detected by comparing the study population (with available data) to an age, gender, ethnicity, poverty level and time-point matched National Health and Nutrition Examination Survey (NHANES) data set using odds ratios.

While that sounds pretty easy (not), it seems to the DMCB that it was the control population that was the critical factor in the reaching the study’s conclusions. In addition, odds ratios, compared to other approaches, can be difficult to fathom. Stakeholders not familiar with research techniques (for example, the human resource person in charge of a TPA, or a staffer in a politician’s office) may have difficulty understanding the more subtle dimensions of interpreting these findings. Last but not least, the study was honorably, but let’s face it, commercially funded.

You may say I’m a dreamer, but imagine for a moment if the data from the “Florida: A Healthy State” were available gratis to other researchers who were welcome to confirm the results using another control group or another comparative approach. The DMCB thinks that the conclusions would hold up, that the transparency would reassure stakeholders in academia and policy circles that the findings are for real and, who knows, other important insights about the needs or care of persons with chronic illness would be closer to discovery.

Florida and its citizens would be better off for it.

Just what IS a "Demo" you ask? Read on......

Health Dialog landed a demo!

This announcement made the Disease Management Blog ask just what is the species known as a Medicare/Medicaid “demonstration?” With the aid of some buddies, I was able to take a guided bus tour of the topic around the web. I’ve learned to think of them as “field tests” that typically involve a waiver of existing CMS regulations that assess whether a change will lead to better efficiency or quality. Referred to as “demos” for short, they can be approved by Congress (usually as a part of a legislative package) or initiated by CMS under a provision in the law that gives the Secretary of HHS “demonstration authority.” Even if a demo is approved, however, funding is by no means guaranteed. Those bucks may have to come via Congress through a separate bill. Funding may also come out of other existing pots of money, but they often need approval by other entities such as the Office of Management and Budget. (As an aside, the disease management blog wonders if this could account for some of the radio silence on the Medical Home Demo, but I digress)

Then it’s up to CMS to author the specific language that actually kicks off the demo. This language includes the request for proposals (RFP), which are published in the Federal Register. It takes full-time insiders to anticipate coming demos or read the Register. Either that or a prescription for Ritalin. Not all demos are necessarily awarded through a public bidding process. They can be awarded to a specific entity (a favorite approach is earmarks) or written so narrowly that any competition is nil.

Companies pursue RFPs for several reasons, including the chance to prove to CMS that a waiver should be made permanent or their product or service deserves to be permanently covered by Medicare. It can also lead to other demos, especially if the previous track record is good. It can also generate some important PR, such as the attention of the Disease Management Care Blog. Companies also gain considerable experience in delivering their product or service. While the economic payoff in the short term may not be that great, if CMS ultimately decides to include the product or service as a permanent part of the Medicare benefit, the payoff can be huge.

With some trepidation, the Disease Management Blog donned his trusty dive suit and entered the CMS demo web site. It found a ten page list of 52 demos (5 are closed). More details on the Health Dialog announcement can be found here. It looks like this will be a three arm randomized trial where beneficiaries will be assigned to either 1) a health risk assessment (HRA) questionnaire plus generic healthy life style advice, 2) an HRA plus advice tailored to the HRA or 3) an HRA plus intensive counseling. Participants will also be linked to other community based health promotion programs.

It appears Health Dialog was not only awardee. The others are Focused Health Solutions, HealthPartners, Pfizer Health Solutions and StayWell Health Management. It begins in April of 2008, and will end in September of 2011.