Health Dialog, prior to its acquisition by global healthcare provider BUPA, was one of the most rapidly growing, privately owned care management services firms in the United States. Headquartered in Boston, MA, Health Dialog works to improve the quality of our healthcare system while curtailing overall expenses. In 2005, Health Dialog was invited by Centers for Medicare & Medicaid Services (CMS) to join the Medicare Health Support (MHS) pilot program, an initiative created by Section 721 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, to test care management solutions on 20,000 Medicare fee-for-service (FFS) beneficiaries from Western Pennsylvania.
Health Dialog’s goal for Phase I of the MHS pilot was to increase the use of preventative care, reduce the number of unnecessary hospital stays, and avoid expensive and devastating health complications. Although CMS determined the MHS pilot program had met the stated goals of achieving physician participation and patient satisfaction it concluded the financial cost savings benchmarks had not been reached. Health Dialog and its peer MHS organizations, those companies participating in the MHS pilot program, argued the parameters of the pilot, specifically the populations that were made available for treatment, were faulty. Despite the MHS organization’s protestations, CMS chose not to move forward with Phase II of the MHS program which specifically called for a wider rollout of care management services in fee for service Medicare.
O’Neill and Associates developed and implemented a federal government relations strategy that raised awareness to the imperfect nature of the pilot and sought a retooling of the program. O’Neill and Associates successfully advanced these issues to a national arena by arranging meetings for founder and CEO George Bennett with key Members of Congress, and their senior health care policy staff, with oversight responsibilities on healthcare issues including Speaker of the House Nancy Pelosi; Senator Edward Kennedy, Chairman, Committee on Health, Education, Labor and Pensions; Senator John Kerry, Committee on Finance, Subcommittee on Health; Representative Charles Rangel, Chairman, Committee on Ways and Means; and Representative Pete Stark, Chairman, Committee on Ways and Means, Subcommittee on Health.
O’Neill and Associates’ team educated Members of Congress on the benefits of care management in fee for service Medicare and the need to provide an opportunity for companies like Health Dialog to demonstrate its effectiveness in an appropriately controlled environment. Disease management has been revisited in general terms in the final health care legislation signed by President Obama on March 23, 2010.
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