Better Health Care Turns Out to Be Really, Really Hard

For indispensable reporting on the coronavirus crisis and more, subscribe to Mother Jones' newsletters.

Today the CBO released a study of various demonstration programs designed to improve care and reduce costs for Medicare patients. One category of program, disease management and care coordination, attempts to get patients with chronic illnesses to understand their treatment better and take better care of themselves. The goal is to reduce hospital admissions. So how did that work out?

On average, the 34 care coordination and disease management programs had little or no effect on hospital admissions or regular Medicare spending…

Bad news! But maybe not. As the chart on the right shows, there was a very wide variance in the effectiveness of the programs. So while the average may have been zero, having lots of different programs allows us some insight into which ones worked and which ones didn’t. For example:

The programs used nurses as care managers to educate patients about their chronic illnesses, encourage them to follow self-care regimens, monitor their health, and track whether they received recommended tests and treatments. In most programs, the care managers were not integrated into physicians’ practices, and their contact with patients was primarily by telephone. In some programs, however, the care managers either were employed in physicians’ officesHospital admissions fell by an average of 7 percent and regular Medicare spending declined by an average of 6 percent for programs in which care managers had substantial direct interactions with physicians. In contrast, there was no effect, on average, on hospital admissions or spending resulting from programs in which care managers had little or no direct interaction with physicians.

So perhaps we’ve learned something. These kinds of program can reduce costs, but it turns out that financial incentives didn’t make much difference. What did make a difference was allowing the nurses doing the care coordination to spend a lot of time with the primary physicians.

Unfortunately, there’s some additional bad news. First, even the programs that worked didn’t reduce overall costs because their savings were less than the fees they were paid to implement the program in the first place. Second, it’s not clear that outcomes improved much: “Although the programs increased the percentage of beneficiaries who reported being taught self-management skills, they had little or no effect on the percentage who reported that they were adhering to prescribed self-care regimens.” Back to the drawing board.

Thank you!

We didn't know what to expect when we told you we needed to raise $400,000 before our fiscal year closed on June 30, and we're thrilled to report that our incredible community of readers contributed some $415,000 to help us keep charging as hard as we can during this crazy year.

You just sent an incredible message: that quality journalism doesn't have to answer to advertisers, billionaires, or hedge funds; that newsrooms can eke out an existence thanks primarily to the generosity of its readers. That's so powerful. Especially during what's been called a "media extinction event" when those looking to make a profit from the news pull back, the Mother Jones community steps in.

The months and years ahead won't be easy. Far from it. But there's no one we'd rather face the big challenges with than you, our committed and passionate readers, and our team of fearless reporters who show up every day.

Thank you!

We didn't know what to expect when we told you we needed to raise $400,000 before our fiscal year closed on June 30, and we're thrilled to report that our incredible community of readers contributed some $415,000 to help us keep charging as hard as we can during this crazy year.

You just sent an incredible message: that quality journalism doesn't have to answer to advertisers, billionaires, or hedge funds; that newsrooms can eke out an existence thanks primarily to the generosity of its readers. That's so powerful. Especially during what's been called a "media extinction event" when those looking to make a profit from the news pull back, the Mother Jones community steps in.

The months and years ahead won't be easy. Far from it. But there's no one we'd rather face the big challenges with than you, our committed and passionate readers, and our team of fearless reporters who show up every day.

We Recommend

Latest

Sign up for our newsletters

Subscribe and we'll send Mother Jones straight to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate