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Delivery System Day: David Cutler

13.jpgDavid Cutler is Dean of the Social Sciences and Otto Eckstein Professor of Applied Economics at Harvard University, which, you'll have to admit, is pretty impressive. He was also one of the Obama campaign's most influential health-care policy advisers. The key, he says, is the experimentation with better models for coordinated care that's funded and encouraged in the bill.

[Max Baucus's] chairman’s mark has a little noticed but very important provision to establish a Chronic Care Management Innovation Center at CMS. The Center, funded at $1 billion per year, would experiment with different ways to encourage evidence-based, coordinated care. Reforms that improve quality and reduce costs could be expanded nationally without further legislation.

Improved chronic care management is a key part of necessary reform. It is what will turn the dream of prevention into a reality, improving health and saving money. Further, the idea of experimentation is exactly right. We don’t know all the steps to take in reform. But we have a number of ideas. Those ideas should be tested, refined, and then expanded or dropped as appropriate. The chronic care management center is a model for how payment reform might work as a whole.

By Ezra Klein  |  September 22, 2009; 12:05 PM ET
Categories:  Health Reform  
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Next: Delivery System Day: Sara Rosenbaum


In other words, a nazifascistcommie Death Panel...

Posted by: luko | September 22, 2009 12:27 PM | Report abuse

I look forward to seeing and hearing how the right wing idiots manage to twist the word "experiment" in this provision. Visions of Glen Beck and Josef Mengele are dancing in my head.

The stoopid - it burns.

Posted by: donovong | September 22, 2009 12:29 PM | Report abuse

--"Those ideas should be tested, refined, and then expanded or dropped as appropriate."--

In the private sector, where people play with their own assets, the "appropriate" part is decided by evaluating the risk versus the rewards, with the risk of failure looming large in the mind of the person making the decision. That risk *has* to be accounted for.

In the public sector, playing with other people's money, there's little incentive to fear outsized risks, or even to not purposely waste the money in an effort to prolong one's job, etc.

Pretending that the two sectors operate similarly is dishonest, Cutler.

Posted by: msoja | September 22, 2009 1:47 PM | Report abuse

--"pretty impressive"--

I'm not impressed, Klein, by appeals to authority. It's Harvard graduates who are having a big hand at running this country into the ground. I don't think the education there is what it used to be.

Posted by: msoja | September 22, 2009 1:51 PM | Report abuse

this seems to build on some existing chronic care pilots at CMS that have shown solid results; remember that CMS already does do pilot programs. I think they're putting them all under one roof and not only throwing support by one's that work, but improving that process.

Also, to your list of ideas Ezra, I'd add the proposals of 'comprehensive care payments'. Sort of between capitation and a DRG; like a condition-specific capitation that doesn't incentivize repeat visits. Certainly worth a pilot program.

Posted by: ThomasEN | September 23, 2009 8:59 AM | Report abuse

--"[T]hey're putting them all under one roof and not only throwing support by one's that work, but improving that process."--

That's government for you. Eternally attempting to understand how one tells when something has worked, and never realizing that only *individuals*, freely making choices with their own assets, mark endeavors as successes or failures.

The government is like an investor throwing darts at a stock exchange list and then trying to anticipate success by consulting an astrologer.

Posted by: msoja | September 23, 2009 9:29 AM | Report abuse

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