Dis­ap­point­ing re­sults cast doubt on prom­ise of cost sav­ings from key re­form pro­vi­sions

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Many in health­care, in­clud­ing lead­ers at the CMS In­no­va­tion Cen­ter, are bet­ting on ex­per­i­ments with more co­or­di­nated ser­vices and value-based pay­ments to show it’s pos­si­ble to spend less for bet­ter out­comes. For two decades, the Medi­care pro­gram has tried some of these ideas—and now a new fed­eral re­port has some bad news about the re­sults.

Last week, the non­par­ti­san Con­gres­sional Bud­get Of­fice re­ported that a study of 10 ma­jor demon­stra­tion projects in care co­or­di­na­tion and value-based pay­ment showed that most pro­grams did not re­duce Medi­care spend­ing. De­spite the dis­cour­ag­ing con­clu­sion, providers and re­searchers alike say there’s too much prom­ise to give up on the demon­stra­tion con­cept just yet.

The CBO’S find­ings ex­am­ined the out­comes of six dis­ease-man­age­ment and care-co­or­di­na­tion demon­stra­tions and four value-based pay­ment projects. For the for­mer, the pro­grams aimed to im­prove the qual­ity of care for ben­e­fi­cia­ries with chronic ill­nesses whose health­care is par­tic­u­larly ex­pen­sive. In the lat­ter cat­e­gory, providers were given fi­nan­cial in­cen­tives to im­prove the qual­ity and ef­fi­ciency of care—as op­posed to pay­ments based on vol­ume and in­ten­sity of ser­vices de­liv­ered.

Ac­cord­ing to the re­sults, in nearly ev­ery pro­gram that in­volved dis­ease man­age­ment and care co­or­di­na­tion, spend­ing was ei­ther un­changed or in­creased rel­a­tive to the spend­ing that would have taken place if the pro­gram didn’t ex­ist—when the fees paid to the pro­gram were taken into ac­count. Sim­i­larly, the re­sults for the value-based pay­ment projects pro­duced lit­tle or no sav­ings for the Medi­care pro­gram, the study showed.

Randy Brown, vice pres­i­dent and di­rec­tor of health re­search at Math­e­mat­ica Pol­icy Re­search, said the study’s con­clu­sion that the dis­ease-man­age­ment and care-co­or­di­na­tion projects didn’t lower Medi­care spend­ing is not sur­pris­ing. First, it’s hard to save money on a very sick pa­tient pop­u­la­tion with chronic prob­lems such as heart dis­ease or di­a­betes. For ex­am­ple, Brown said a pa­tient in this group could have both arthri­tis and heart dis­ease—and could be told by an arthri­tis spe­cial­ist to stay off his feet, while his car­di­ol­o­gist in­structs him to get on a tread­mill.

A nurse care man­ager with Health Qual­ity Part­ners pays a per­sonal visit to a pa­tient, a fea­ture shared by suc­cess­ful dis­ease-man­age­ment demon­stra­tions.

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