Medicare payments; in each location, approximately 20,000 such people were randomly assigned to an intervention group and 10,000 were randomly assigned to a control group. CMS set goals in the areas of clinical quality and beneficiary satisfaction, and negotiated with the disease management programs for a target of 5% savings in Medicare costs. The programs started between August 2005 and January 2006. What is now the Care Continuum Alliance praised the project as "the first-ever national pilot integrating sophisticated care management techniques into the Medicare fee-for-service program". An initial evaluation of Phase I of the project by RTI International appeared in June 2007 which had "three key participation and financial findings": Medicare expenditures for the intervention group were higher than those of the comparison group by the time the pilots started. Within the intervention group, participants had lower Medicare payments (i.e., tended to be healthier) than non-participants. The "fees paid to date far exceed any savings produced." DMAA focused on another finding of the initial evaluation, the "high levels of satisfaction with chronic disease management services among beneficiaries and physicians". One commentary noted that the project "can only be observational" since "equivalence was not achieved at baseline". Another commentary claimed that the project was "in big trouble". A paper on the six-month evaluation, published in fall 2008, concluded that "Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization". In December 2007, CMS changed the financial threshold from 5% savings to budget neutrality, a change that DMAA "hailed". In January 2008, however, CMS decided to end Phase I because it claimed that the statutory authority had run out. Four U.S. senators wrote a letter to CMS to reverse its decision. DMAA decried the termination of Phase I and called upon CMS to start Phase II as soon as possible. Among other criticisms of the project, the disease management companies claimed that Medicare "signed up patients who were much sicker than they had expected," failed to transmit information on patients' prescriptions and laboratory results to them in a timely fashion, and disallowed the companies from selecting patients most likely to benefit from disease management. By April 2008, CMS had spent $360 million on the project. The individual programs ended between December 2006 and August 2008. The results of the program were published in The New England Journal of Medicine in November 2011. Comparing the 163,107