Healthways Announces Achievements in Medicare Health Support; Other Seniors’ Programs

Findings Frame Future Approach for Better Care, Better Health and Lower Cost for Seniors in America and Abroad

NASHVILLE, Tenn.--(BUSINESS WIRE)-- Ben R. Leedle, Jr., Chief Executive Officer of Healthways (NASDAQ: HWAY), today announced the company’s Medicare Health Support findings, which demonstrate the efficacy of Healthways’ programs with respect to key measures – clinical, financial, satisfaction and engagement. Leedle presented the findings preceding a panel discussion of their implications with former Speaker of the House Newt Gingrich, former U.S. Senate Majority Leader Tom Daschle and Kenneth E. Thorpe, Ph.D., Chair of the Department of Public Health at Emory University and Executive Director of the Partnership to Fight Chronic Disease at a Center for Health Transformation meeting in Washington, D.C.

The Healthways Medicare Health Support initiative, which involved a total of more than 26,000 Medicare beneficiaries in the original and refresh cohorts, was part of an unprecedented effort developed by the Centers for Medicare and Medicaid Services (CMS) pursuant to the Medicare Modernization Act of 2003. The purpose of the program was to demonstrate, through a randomized control trial, the efficacy of adapting successful commercial chronic care management programs for fee-for-service Medicare beneficiaries and to gain knowledge that would be critical for implementing future solutions for Medicare.

Healthways results, as documented by CMS reports, demonstrate achievement in Medicare Health Support with respect to clinical, financial, satisfaction and engagement measures.

CMS Findings on Healthways’ Medicare Health Support Program

Clinical Healthways was the only Medicare Health Support Organization to achieve statistically significant improvement in all five process of care measures – cholesterol screening for participants with heart failure, cholesterol screening for participants with diabetes, HbA1c testing, urine protein screening and retinal eye exams – as evaluated during months 7 – 18 of the program.1 At the conclusion of the program, Healthways had also achieved improvements in the key clinical metrics of blood pressure control, pneumococcal vaccination rates and annual depression screening.2 Healthways achieved 92 percent of performance-based fees related to clinical improvement.2   Financial Healthways achieved cumulative gross savings in both its original and refresh cohorts. 3 Healthways achieved net savings as compared to the control group for the beneficiaries in its refresh cohort.3   Satisfaction Healthways program met or exceeded all beneficiary2 and physician satisfaction targets.1 Healthways achieved 94 percent beneficiary satisfaction against the Medicare Health Support target of 65 percent.1 Healthways achieved 100 percent of performance-based fees related to beneficiary satisfaction.2   Engagement Healthways achieved an audited consent rate of 89 percent of eligible participants.1 Healthways achieved a continuous participation rate after consent of 65 percent for the first 18 months of the three-year program.1

Healthways’ learnings have been advanced in the two years since the end of Medicare Health Support through additional third-party research conducted by scientists at the Rollins School of Public Health at Emory University; the Institute for Quantitative Social Science at Harvard University, in association with the University of Milan and the University of Trieste; and Healthways’ Center for Health Research. This research was undertaken to better understand the performance of our programs and apply that knowledge to the design and development of future programs for seniors. These learnings fall into three categories: design and comparability, treatment effect and end of life.

Design and Comparability

In its First Report to Congress³, Research Triangle Institute, the Medicare Health Support Independent Evaluator, identified a substantive disparity in baseline cost between the intervention and control groups for a number of the Medicare Health Support programs including Healthways. Scientists from Harvard and their associates support the Center for Health Research in applying the recently developed and validated Coarsened Exact Matching (CEM) methodology⁴ to Healthways control and intervention cohorts data. The application of CEM to Healthways Medicare Health Support data provided a better approximation of actual comparability, or balance between the control and intervention groups, which in turn enabled a better approximation of financial impact.

According to Gary King, Ph.D., Director of the Institute for Quantitative Social Science at Harvard, “In an ideal randomized clinical trial, the intervention and control populations are evenly balanced. That did not happen with Healthways Medicare Health Support cohorts. Due to observed imbalance in cost at baseline between the control and intervention groups, and inefficiencies in the experimental design, RTI's observation that ‘None of the MHSOs showed either statistically slower or faster rates of growth in intervention PBPMs relative to their comparison group.’ should probably be taken as a comment on the lack of power of the experiment, not necessarily of the failure of the MHSOs to achieve savings.”

Treatment Effect

The Emory researchers assessed the impact of beneficiary participation on costs and savings. They found that annual savings increased with both the extent of beneficiary participation and clinical risk score. Savings were achieved for all fully participating beneficiaries, regardless of clinical risk levels, supporting a strong “treatment effect” for Healthways’ Medicare Health Support program design and delivery.

“Healthways’ results in Medicare Health Support offer more proof that we know what works and that we have the ability to improve health and lower costs by engaging people and providing them with the support they need,” said Dr. Thorpe.

End of Life

The high severity of disease in this population resulted in an increased rate of death as compared to the general Medicare population. The Healthways’ Center for Health Research examined the impact of death in both the control and intervention group. The Healthways’ Medicare Health Support program included specific integrated support designed to assist beneficiaries, their families and caregivers with respect to end-of-life choices. Healthways’ high engagement rate with this subset of the population reflected a very high acceptance for this type of support; choices made by the beneficiaries in the intervention group resulted in an average reduction of costs of $1,913 per individual in the last six months of life as compared to the control group.

Healthways’ Medicare Health Support Subsequent Research Findings

Design and Comparability   General Original intervention and control cohorts were not balanced.4 Balance was not produced with respect to cost at baseline.5 Since prior cost is one of the strongest predictors of future cost, cost at baseline is an important variable and its imbalance magnifies the overall imbalance between the intervention and control cohorts. 5,6 The Coarsened Exact Matching methodology was applied to data for Healthways’ Medicare Health Support program to account for the imbalance between the intervention and control cohorts and reassess financial results.5,6   Financial Based on the CEM analysis, the estimate of Healthways’ original intervention cohort net cost savings is $73 per beneficiary per month over the three year period, for a cumulative net savings of $44 million, or 4.5 percent. 5,6

Treatment Effect   Financial7 Mean savings for fully participating beneficiaries was $2,848 per year. Savings were achieved for fully participating beneficiaries regardless of risk score.   Engagement Continuous participation in the Healthways’ program was more than 80 percent for the full 12-month period and more than 90 percent for six or more months in 2007.1

End of Life   Financial Healthways End-of-Life predictive model enabled successful contact with 80 percent of predicted decedents and cost reduction of $1,913 per individual in last six months of life.8

During the presentation, Healthways also reported findings supporting the efficacy of a population health approach for improving health outcomes and reducing costs for seniors, both domestically and internationally.

Other Healthways Seniors’ Research and Program Findings

Healthways SilverSneakersTMFitness Program9 Medicare beneficiaries with diabetes who participated in a Silver Sneakers program had lower costs, as compared to non-participants, of $1,633 in year one and an additional $1,230 in year two. In the same study, participants with diabetes achieved a 29 percent lower hospitalization rate compared to controls. The cost savings were largely attributable to lower inpatient costs associated with this reduction in hospital admissions.

Risk Reduction in Medicare Preventing or slowing health risk progression could save $652 billion to $1.4 trillion over 10 years while extending average life expectancy by 2.4-5.7 years.10

“Our findings in Germany are particularly important since the program we are providing is the single largest multi-condition chronic care management program outside of the United States,” Leedle added. “Our results demonstrate that our approach for senior populations is effective both domestically and abroad. Further, our approach offers a clear path for governments who are facing the confounding challenges of adding productive years of life for the senior population, while reducing the cost of providing them with optimized health care services.

Healthways Multi-Condition Chronic Care Program in Germany11 Hospital admissions for participants aged 65 or older decreased 6 percent in the intervention group as compared to an increase of 18.9 percent in the control group – a net improvement in the admission rate of 24.9 points – in the first year of the program. The reduction in admissions was greatest – 15.3 percent – among the highest severity members in the intervention group in contrast to an 8.2 percent increase in the control group – a net improvement in the admission rate of 23.5 points.

“For more than a decade, Healthways has maintained that chronic disease and population health programs are not homogeneous; that design, implementation and execution matters; that the only way to meaningfully differentiate among programs is by careful examination of the outcomes that are actually produced. We are both pleased and proud to add these research findings to the expansive body of proof of the effectiveness of our solutions.

“One of the primary goals of the Medicare Health Support program was to gain critical knowledge for implementing future solutions for Medicare through this type of public-private collaboration,” Leedle said. “We believe both Healthways and CMS achieved that goal. While there were well-documented and legitimate disagreements with CMS over the most accurate approach to measuring success, we understand CMS’ perspective and are continuing to work cooperatively to resolve those differences.

“Public-private collaborations, such as Medicare Health Support, represent our greatest chance for future success,” Leedle concluded. “We look forward to working with all stakeholders to design and implement the comprehensive solution model suggested by these findings and are confident that it will deliver better care, better health and lower cost for seniors.”

For more information on Healthways’ findings or to view the results in more detail, please go to www.healthways.com.

About Healthways

Healthways is the leading provider of specialized, comprehensive solutions to help millions of people maintain or improve their health and well-being and, as a result, reduce overall costs. Healthways' solutions are designed to keep healthy people healthy, mitigate or eliminate lifestyle risk factors that can lead to disease and optimize care for those with chronic illness. Our proven, evidence-based programs provide highly specific and personalized interventions for each individual in a population, irrespective of age or health status, and are delivered to consumers by phone, mail, internet and face-to-face interactions, both domestically and internationally. Healthways also provides a national, fully accredited complementary and alternative Health Provider Network and a national Fitness Center Network, offering convenient access to individuals who seek health services outside of, and in conjunction with, the traditional healthcare system. For more information, please visit www.healthways.com.

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1		Evaluation of Phase I of the Medicare Health Support Pilot Program Under Traditional Fee-for-Service Medicare: 18-Month Interim Analysis, Report to Congress, prepared for CMS by RTI, International, October 2008
2		Final Liability for Performance Monitoring Report of CMS Contractor Mathematica Policy Research, April 7, 2009
3		Evaluation of Phase I of Medicare Health Support (Formerly Voluntary Chronic Care Improvement) Pilot Program Under Traditional Fee-for-Service Medicare, Report to Congress, prepared for CMS by RTI, International, June 2007
4		Causal Inference Without Balance Checking: Coarsened Exact Matching. King et al. (2009); http://gking.harvard.edu/files/cem-plus.pdf
5		Institute for Quantitative Social Science at Harvard University Research Report, September 2010
6		Center for Health Research Research Report, September 2009
7		Atherly, A. J.; “Analysis of the Treatment Effect of Healthways Medicare Health Support Phase I Pilot Program;” Department of Health Policy and Management,” Rollins School of Public Health, Emory University; publication pending
8		Hamlet, K. S.; et al; “Impact of Predictive Model-Directed End-of-Life Counseling for Medicare Beneficiaries,” The American Journal of Managed Care, Vol. 16, No. 5, 379-384
9		Nguyen H.Q.; et al; “Managed-Medicare health club benefit and reduced health care costs among older adults,” Prevention Chronic Disease, 2008;5 (1):A14.
10		Center for Health Transformation, Ingenix; “Potential Medicare Savings Through Prevention and Health Risk Reduction,” 2009
11		Rula, R.; Pope, J., MD; “The Impact of a Proactive Chronic Care Management Program on Hospital Admission Rates in a German Health Insurance Society: An Analysis of Members 65 and Over,” publication pending

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