An article in today’s NY Times, “Reshaping Medicare Brings Hard Choices” by Robert Pear, lays out the narrow set of “choices” that exist within the prevailing mental models of policy makers and politicians. Unfortunately, these miss the best (and perhaps only credible) opportunity to improve care within Medicare while controlling long-term cost – redesigning our care system to more effectively prevent and manage chronic illness.
While few models have compelling proof they can accomplish this, SOME DO; HQP’s model of advanced community-based care management tested in the Medicare Coordinated Care Demonstration, the MGH program implemented within the Care Management for High Cost Beneficiaries Demonstration, and the Transitional Care Model, to name a few (along with a small handful of other successful models that have undergone rigorous testing). Yet CMS has not posted (as of today) the results of the successful HQP and MGH demonstrations on their Medicare Demonstrations website, they are not widely known, and they have not yet served as the catalyst they should to force health policy makers to think differently. Thankfully, CMS just launched the Community Based Care Transition Program.
We need new mental models to address this challenge and there is strong evidence to compel us to adopt them. Until we do, the best opportunities for health reform will remain undiscovered and underutilized. The debate will continue to be framed in ideological, power, market share, and economic terms, endlessly swirling about, tipping now to the right, then to the left; over and over again. Instead, if we set as our aim, improving health outcomes as cost effectively as possible, (and measure our progress accordingly) we would make different policy decisions, and would insist on the broad application and improvement of emerging models with evidence of effectiveness.
We need new mental models to address this challenge and there is strong evidence to compel us to adopt them. Until we do, the best opportunities for health reform will remain undiscovered and underutilized. The debate will continue to be framed in ideological, power, market share, and economic terms, endlessly swirling about, tipping now to the right, then to the left; over and over again. Instead, if we set as our aim, improving health outcomes as cost effectively as possible, (and measure our progress accordingly) we would make different policy decisions, and would insist on the broad application and improvement of emerging models with evidence of effectiveness.