Thoughts on potential new directions in Medicare

Over at Let’s Talk Health Care, Charlie Baker has been musing about how to wrestle with the intractable problems of Medicare, citing a WSJ piece by a Sloan-Kettering doc who observed, in Charlie’s words: "Care is more ongoing and multi-disciplinary than it’s ever been, and Medicare has no way of recognizing this new fact, or aligning with it financially."

Fast forward through the comments, and we have Charlie concluding that the learning from Medicare demonstration projects

[doesn’t] find [its] way into the larger platform that the baseline program operates on. This makes me wonder if the only way to go at this would be a statewide demonstration (I can’t believe I’m saying this – MA had something kind of like this back in the late 1980s when the state set all hospital rates, including Medicare rates). Might be worth considering – as a way to get everyone in MA on the same page.

Initially, I couldn’t believe he was saying this either, but upon reflection it seems to me that this is yet another way that CMS could expand the sandbox, so to speak.  The federales have been pretty actively throwing a lot of stuff against the wall to see what might stick, including the Senior Care Organization demonstration here in Massachusetts for dual eligibles (Medicare and Medicaid).  It would, in fact, be interesting to see a statewide Medicare demonstration incentivizing providers to take more of a collaborative, patient-centered approach to care.

— David Harlow