Blood, sweat, and billions have gone toward studying whether different care delivery models can improve health outcomes of the chronically ill while holding down costs. A recent set of Medicare disease management pilot programs with these twin goals showed, at best, uneven results. As previously noted in this space, only three, including a promising one in Pennsylvania, have been extended beyond their initial periods. Even these programs did no yet reduce overall costs of care for the chronically ill. The key word in that last sentence is "yet."
We must not be fickle in funding delivery system innovation. Politicians and the general public have microscopic attention spans and wildly unrealistic expectations as to how quickly new health care programs can fulfill their promise. This is particularly problematic for innovations that deal with the management of chronic diseases. The problem is compounded when patients are poor, uninsured or underinsured and suffer from illnesses that were undertreated if they were treated at all. As detailed below, the state of California is discovering this at the outset of a major public investment in pilot programs focused on these populations.
Beyond questions of effective long-term stewardship of scarce public resources, there are real human costs to short-lived serial infatuation with new pilot programs. We nearly all believe that a real and ongoing relationship between patient and provider is paramount to quality medical care, yet we often reshuffle which federal program people qualify for and what care facilities they can access. Ideally patients should have some stability and consistency of access points, particularly within a system that can seem byzantine and impenetrable even to those who study health policy for a living.