CBO Issues Report on Care Management and Value-Based Purchasing


The Congressional Budget Office (CBO) released a report on January 18 outlining key findings and lessons learned from six disease management/care coordination projects and four value-based purchasing projects under Medicare research and demonstration authority. Rigorous independent evaluations have been completed on the projects, which were implemented before 2008. The first six demonstration projects, involving 34 separate programs, showed that factors such as the extent and type of care management were important determinants as to whether the programs actually achieved reductions in hospital admissions and net reductions in Medicare program spending after accounting for the extra care management fees under the projects. Only four of the 34 programs achieved reductions in hospital admissions greater than 15 percent. The four value-based purchasing projects, involving 10 separate programs, also showed that some program models worked much better in practice than others. Only one of those 10 programs, a hospital/physician services bundled payment model for coronary bypass patients, showed a statistically significant (over 10 percent) reduction in net expenditures. The Centers for Medicare and Medicaid Services (CMS), Center for Medicare and Medicaid Innovation, indicates lessons learned from the independent evaluations as including the importance of timely dissemination of patient data, such as data on hospital admissions, which can be facilitated by use of electronic health records; focusing on care transition periods (e.g., periods following hospital discharges); using coordinated multi-disciplinary care teams, including nurses, pharmacists, and other professionals with expertise relevant to the patient’s medical condition; targeting care management interventions on the highest risk patients; and calibrating care management fees properly so that the fees don’t offset the savings from improved coordination.   Valuable lessons learned from these Medicare projects are relevant also to Medicaid demonstration projects now being designed by states and new state options under the Affordable Care Act (ACA) such as health homes and accountable care organizations. The full CBO report is available at www.cbo.gov.

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Categories:Health and Human Services


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