January 31, 2012
In light of the recent summary from the Congressional Budget Office (CBO), “Lessons from Medicare's Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment” there has been some short-sighted reporting on the findings of the demonstrations that have left some impressions that I feel need correcting. As I’ve highlighted in a more detailed commentary, it is important to take into account the true scope of the summary and the demonstrations that were conducted in order to provide an accurate assessment of the value of care coordination in Medicare. The solid and growing evidence base around care coordination - the vast majority of which was not included in CBO's document - shows that well-designed programs do work to both improve outcomes and lower costs.
Demonstrations are designed to examine how different program designs affect outcomes. The Medicare disease management and care coordination demonstrations in the report examined a wide range of program designs making broad general conclusions about the programs impossible. While most of the approaches examined did not appear particularly effective, some were, so a reasonable approach here would be to examine the key design features of the successful programs and build on them and to weed out the less successful aspects. Unfortunately though, the reporting on the CBO study simply says care coordination will not work which is just not true.
Would it be entirely fair to suggest that the outcomes concluded from CBO’s brief are results of the debilitating increase of chronic disease in our country and the demand that these diseases put on our health care system? Perhaps. But again, broad generalizations still do not guide us to effective solutions. What is clear is that prevention must be a part of any successful and sustainable cost savings solution for our health care system. Well-designed care coordination and prevention programs can work. If we build on what data and evidence has shown to be effective in order to guide investment in and development of programs and policies aimed at better averting, detecting and managing chronic diseases, like diabetes, heart disease and cancer, we can give it our best shot at transforming the system into one of true health care as opposed to sick care.
What is critical to implementing valuable solutions within our health care system is not to be immediately dismissive of programs that don’t provide 100 percent positive results, but rather to be collaborative in our approach to health care by piecing together a variety of core components that do work – this is exactly the crux of care coordination in the first place. One size fits all is not a productive mindset in health care, and if the overall health of our nation continues on its current path of one of more chronic diseases per patient, this will ring increasingly true as leaders in policy and health care grapple for cost effective ways to manage the health of our nation.