Pilot programs fail


Defenders of the 2010 federal health care overhaul frequently argue that the law will save money through pilot programs that aim to reshape the way medical services are delivered. The idea is to identify policies that provide better health at lower cost. But a January report by the nonpartisan Congressional Budget Office (CBO) suggests such reforms will be hard to achieve. 

Looking at the results of 34 disease management and care coordination programs, the CBO found most did not reduce Medicare spending. "On average, the 34 programs had little or no effect on hospital admissions," the report says. "In nearly every program, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program, when the fees paid to the participating organizations were considered." 

The report also examined four "value-based" payment reforms designed to reduce spending through bundled payments and quality bonuses. The results there were a little better; one of the four programs reduced spending on services related to heart bypass surgeries by about 10 percent. But the overall results were still discouraging: According to the CBO, the other three reforms "appear to have resulted in little or no savings for Medicare."