Lessons for the new CMS innovation center from the Medicare health support program.

The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program that ran between 2005 and 2008, illustrate the value of drawing on experience in planning for the center and future pilot programs. The lessons include the importance of strong leadership; collaboration and flexibility to foster innovation; receptivity of beneficiaries to care management; and the need for timely data on patients' status. The lessons also highlight pitfalls to be avoided in planning future pilot programs, such as flawed strategies for selecting populations to target when testing payment and service delivery reforms.

Next steps: how can Medicare accelerate the pace of improving chronic care?

David Bott and colleagues report little success so far in demonstrations and pilot programs undertaken since 1999 to improve chronic disease management in the traditional Medicare program. The findings presented are highly generalized. To accelerate learning and progress, the Centers for Medicare and Medicaid Services (CMS) should expedite release of program-specific evaluations and data for external review. In addition, experience from the quality improvement field suggests that a new approach to program development would be beneficial, featuring intensified collaboration and data exchange to facilitate rapid program improvement, and application of a broader set of scientific methods than are used in clinical trials to gauge results.

Crossroads in quality.

Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost. We identify five fundamental building blocks for a high-performance health system and urge action to create a national center for effectiveness research, develop models of accountable health care entities capable of providing integrated and coordinated care, develop payment models to reward high-value care, develop a national strategy for performance measurement, and pursue a multistakeholder approach to improving population health.

Medicare health support: reinventing chronic care.

Medicare Health Support is a groundbreaking new initiative to help chronically ill Medicare beneficiaries improve their health and quality of life. If the ongoing pilot programs are successful, they may have far-reaching effects on population health and patient care.

Chronic care improvement in Medicare FFS: cosmetic or transforming?

As part of the Medicare Modernization Act of 2003, Congress mandated development of "Voluntary Chronic Care Improvement Programs under Traditional Fee-For-Service." These programs represent an ambitious new federal attempt to reduce quality failings under the Medicare fee-for-service (FFS) plan cost-effectively and on a large scale. CCI programs cannot be expected to rescue Medicare from current cost pressures or from the perverse incentives inherent in FFS provider reimbursement, but they may reduce health risks, yield savings, and foster progress toward system integration on behalf of some major subgroups of chronically ill beneficiaries who need added support to manage their health effectively.

Population-based disease management under fee-for-service Medicare.

Medicare policymakers are considering testing population-based disease management (PDM) programs under fee-for-service (FFS) Medicare as a way to improve health and cost outcomes for selected subgroups of chronically ill beneficiaries. This paper provides a brief overview of how PDM programs are evolving in the private sector and describes how they differ from other approaches already being tested in Medicare disease management demonstrations. It also discusses some key opportunities and issues to be considered in adapting PDM programs for testing in the FFS Medicare context.