Over several years Medicare has tried two broad categories of demonstration projects to improve care and to see if it is possible to reduce health care expenses. The two categories are 'disease management and care coordination' projects to attempt to improve the care of beneficiaries with chronic illnesses, and 'value-based payment' projects that attempt to incentivize health care providers to improve the quality and efficiency of care, as opposed to fee for service type payments...
The report linked to above provides the results of these demonstration projects (as analyzed by the CBO)... The main conclusions:
- "... most programs have not reduced Medicare spending...", and,
- "Demonstrations aimed at reducing spending and increasing quality of care face significant challenges in overcoming the incentives inherent in Medicare’s fee-for-service payment system... The results of those Medicare demonstrations suggest that substantial changes to payment and delivery systems will probably be necessary for programs involving disease management and care coordination or value-based payment to significantly reduce spending and either maintain or improve the quality of care provided to patients."