LifeMasters

Jan 19, 2011

Share | Tweet | Share | +1 | Buffer | print | email In my post from Monday on LifeMasters seeking Chapter 11, I dropped a BTW comment. The part that’s puzzling to me is the statement that LifeMasters owes $125 M to CMS. That’s hard to figure…the company only participated in MHS for a few months, and to my knowledge MHS is the only Medicare demo that required guaranteed savings (i.e., payback if targets aren’t hit). I really have to stretch my imagination to compute how CMS ran the tab to such an astronomical number. It raises questions around CMS’ good faith as a business “partner”. Let’s do the math. LifeMasters participated in MHS from 8/05 through 12/06 — 17 months. Estimated monthly “fees” advanced by CMS — under $40 M   (20,000 patients x .90 participation rate x $130 per patient per month x 17 months — this is a high estimate) How do you explain the difference between $125 M (amount supposedly owed) and $40 M (estimated actual payments to LifeMasters)? CMS claims LifeMasters can’t get out of the contract? CMS not flexible on full 3 year comparison of intervention vs. control group? CMS still insists on 5% savings from LifeMasters? (even though it later allowed other MHSOs to back off to break even vs. 5% savings? something else? So how could LifeMasters wind up owing CMS $125 Million!!!??? The title of this series of blog posts has been “CMS Bumps Off Medicare Health Support”. I think that’s the right imagery. Mr. O, CMS seems to be a good place to start with your campaign to reform government and make it transparent. Updated: 3:30 PM, 9/17/09 A colleague called and politely tapped me on the shoulder about my back-of-the-envelope calculations about how LifeMasters owes $125M to CMS. LifeMasters had 3 separate contracts with CMS; my math only accounted for LifeMasters Oklahoma Medicare Health Support (MHS) project. While I wish that my colleague would have felt comfortable posting a comment on the blog or to the broader DM listserv, I understand there are many sensitivities involved. So, I stand corrected on my math. My concerns about lack of transparency around MHS remain. Table of contents for the series--CMS Bumps Off Medicare Health Support