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Medicare’s Wellness Programs

By March 1, 2018Commentary

As in the commercial plan world, several Medicare vendors have used wellness programs in an attempt to improve health and hopefully reduce costs.  Congress mandated that an independent evaluation of these efforts be conducted by CMS and Acumen was hired to do the work and has released its report.   (Acumen Report)   The evaluation was to look at programs directed toward mental health, fall prevention, physical activity, nutrition and obesity and chronic disease, and the researchers identified six programs that addressed some of these areas.  They looked at utilization, cost and quality of life outcomes.  Participants in the program were compared with matched controls.  At a high level, the programs appeared to improve self-reported physical and mental health status.  The fall prevention program increased confidence in balance.  For fall prevention and physical activity, obesity and nutrition, there were no significant changes either way in utilization and spending, but for chronic disease management, costs actually increased, which is consistent with other research.  This is probably due to needed care that had been missed for these patients.  Longer-term follow-up might show that over time, as patients get more recommended care, there is a reduction in spending.  The improved functional and mental health status in participants versus controls was a result more of a lack of a decline in participants, indicating that these wellness programs can prevent decreases in functionality and mental status that would otherwise occur as people age.  The number of programs studied and the populations involved were relatively small, and the time periods involved fairly short.  But the results are consistent with other research showing mixed short-term outcomes for wellness efforts.  It is important, however, to withhold judgment on the value until longer term, more rigorous studies can be conducted.  And the improvement in functional status has a value of its own, regardless of spending impacts.


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