Challenge

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.