Back in January 2010, I wrote that the best evidence suggested that the so-called “game changers” included as part of the health reform legislation were unlikely to do much to restrain healthcare costs. The main reason that policies such as disease management and preventive care wouldn’t save much money is that it costs money to apply these methods to every patient, but only a relative few will benefit from them. Furthermore, it is hard to predict who those patients will be.
Now, following a review of experimental demonstration projects on disease management, care coordination, and value-based payment in Medicare, the Congressional Budget Office reports: “CBO reviewed the outcomes of 10 major demonstrations that have been evaluated by independent researchers. The evaluations show that most programs have not reduced Medicare spending.” Some demonstration projects fared better than others. For instance, programs promoting stronger patient–doctor interaction were more likely to generate savings, but even most projects of this type didn’t break even.
If we knew then what we know now—that the long-term care programs added to healthcare reform to sweeten the budget numbers were unsustainable, and that so-called game changers such as disease management didn’t change the game much at all—it is almost certain that the Affordable Care Act would not have passed through Congress.
What makes this all so galling is that we did know then what we know now: there were plenty of people raising warnings regarding these issues, but Congress and the Obama administration chose to ignore them.