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Just one year ago, Mississippi Medical News reported that Colorado-based McKesson Health Solutions, a nationally recognized leader in disease management for Medicaid beneficiaries, was recruiting 20,000 Mississippians with heart disease and/or diabetes to participate in a voluntary three-year Medical Health Support pilot program.

In March, participating physicians received a letter that McKesson would no longer be involved in the program.

The program, supervised by the Centers for Medicare and Medicaid (CMS), was designed to improve the health and wellness of people by paying physicians for participating in a more detailed treatment protocol that would include more personalized education of their disease, better follow-up and a lot more paperwork. It also involved nurses manning the phones to contact participating patients to ensure they were taking medication as prescribed, keeping doctors appointments and answering questions.

More than 34 healthcare organizations, including the Mississippi State Medical Association (MSMA) and Mississippi Academy of Family Physicians (MAFP), endorsed the pilot program.

MSMA director Charmain Kanosky said the association had agreed to endorse the philosophy of any program that involved physicians as the leaders of the healthcare team. McKesson was the only bidder that would do that.

"Our physicians were concerned when Medicaid released the RFP (request for proposal) that it was written so that only one company would bid on it," Kanosky explained. "We had encouraged the state officials to use more flexibility in the RFP to ensure a competitive bidding process and get the best bidders. A concern that we also noticed was the amount of paperwork required in the McKesson contract. It was somewhat burdensome to physicians.

"In the early stages with McKesson, some physicians waited six months or more to be paid for scores of patients that were participating in the disease management component, so when it was up for re-bid, those were (among) concerns we expressed. We were somewhat disappointed when they could not continue that program. When they got the contract last time, it was for a three-year period. They were maybe a year and a half into it.

"It was my understanding it was not financially feasible for them to continue. With the requirements for them to save so much with the disease management program, they weren't able to meet those goals. It will be very difficult for any company to make significant savings with Mississippi's population. Our population is very ill. We have a very difficult population to treat in that regard. They continue to get Medicaid benefits; they just won't be in the disease management program."

Under the Medicare Health Support's delivery model, patients selected received telephone and community-based care, nursing home based care, complex case management and end-of-life care. They also received educational material with access to 24/7 phone support by triage nurses. The program, which also has a pharmacist, a physician and a program manager, assists physicians with eligible patients by providing tools, such as data-recording software, and quarterly funding. The compensation model was based on timely payments, early rewards for participation, implementation of widely accepted clinic practices, such as aspirin therapy for diabetics, and fair payments to reflect the work performed. Field providers coordinated care with physicians.

Internal medicine specialist, Dr. Henry Flautt, chairman of the Counsel of Medical Services for the MSMA, was an active participant in the McKesson project. Although he said he was one of the physicians who had trouble getting paid in the early stages, it had been resolved and he was surprised at their move to pull out.

"I'm not sure what happened," Flautt said. "At our last meeting, the medical director of McKesson came and spoke to us and told us what was going on, just as they had before. There was a hint that something might not be going on right. She said the numbers hadn't turned out like they hoped. I think they had the patients, but the numbers CMS expected in the improvement in care or whatever their goals were just hadn't been met.

"It wasn't two weeks or a month later that we all got a letter saying they would no longer be doing a pay-for-performance, or pay-for-participation.

"They were paying physicians for doing certain things like lab work and certain tests. I think their goal was to make sure everybody was getting the same standard of care for treatment of diabetes and heart disease. They'd send you information every so often and there were lots of forms to fill out. Then they were contacting patients and following up with them. It was a lot of extra paperwork. They had these pilot programs all over the U.S. There are about eight of these types of companies, but McKesson was the only company that wanted to have a relationship with physicians.

On paper, the concept sounded good, said Flautt.

"Most of these companies call the patients and don't include the physicians," he said. "We didn't have to show proof; I was just giving them numbers. I was surprised to get that letter because I didn't get the feeling they were going to stop, just that they didn't get the numbers they hoped to get."

Even the University of Mississippi Medical Center (UMC) participated in the project by providing, along with McKesson, additional services to the participants such as providing diabetes management classes to approximately 1,000 randomly selected beneficiaries living in Hinds, Madison and Rankin counties. The classes, developed and delivered by UMC experts, were designed to help participants learn more about the effect of diabetes on their overall health, benefits of self-management, medications used to treat the disease, and ways to talk with healthcare providers about diabetes. The educational series was geared to the elderly population and consisted of three 1-hour informal lectures with an additional 30-minute Q&A session.

McKesson Corp. did not respond by press time to numerous requests for inclusion in this article.


July 2007

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