Company reaches $28 million settlement for Medicare program

The Tennesseean: "Healthways Inc. will return $28 million to Medicare's overseer under a settlement related to the company's participation in a pilot program to determine the effectiveness of its nurse-based health coaching for chronically ill seniors." The Centers for Medicare and Medicaid Services had paid the company $72 million for the pilot program, which ended two years ago, under the condition that it meet "specific targets for cost savings, health outcomes and patient satisfaction." The pilot "had involved more than 26,000 Medicare beneficiaries with heart failure and diabetes, among chronic conditions. Nurses called on the participating Medicare beneficiaries to remind them to go for checkups or to take their medications. Medicare later stopped the pilot as questions intensified about its effectiveness." The settlement "ends negotiations over $58 million of that money that was in dispute amid disagreements about results" (Ward, 12/7).

Nashville Business Journal: Healthways argues that it had improved patient health outcomes in all five areas studied. "It has argued that the government was unfair in how it compared its patients to a control group — comparisons that made it harder to achieve savings." After the settlement, the company took away with $44 million from the program, "more than 60 percent of the fees that it received for participating" (Hieb, 12/6).

---

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.