Evaluating Care Coordination Among Medicare Beneficiaries

To the Editor: In understanding the study of the effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries by Dr Peikes and colleagues,¹ it is important to examine the purpose of demonstration programs during the evaluation process. These practical studies are performed to determine which programs work and which do not. Medicare should examine and learn from the failures and even more closely evaluate the successes of the demonstration programs to determine which practices could—and should—be implemented among larger populations. From the demonstration programs described in this study, the medical community learned that the programs with the greatest focus on care coordination reduced costs and patient hospital stays. It indicated that directing efforts toward most-affected populations and establishing healthy lifestyles early in life may be critical to improving the quality of health and the health care system.

Given the growing burden of chronic disease in the United States, exploration and evaluation of new programs to fight these chronic diseases are important for improving health while reducing the burden of health care costs. Chronically ill patients account for more than 96 cents of every dollar spent in Medicare.² Individuals with 2 or more chronic diseases account for 76% of that spending.³ These are diseases that are largely preventable through maintaining a healthy lifestyle and that, even after diagnosis, can be better managed to maintain quality of life and avoid multiple expensive complications. In the absence of immediate action, failure to optimize health by exploring new ways to prevent and manage chronic disease will cost the United States an estimated $4.1 trillion by 2023.⁴ Population-based demonstration programs provide valuable lessons by revealing what works and what still needs refinement to achieve more proactive, evidence-based approaches to reduce health care costs and improve the quality of US health.