WASHINGTON: They work for the government and even their closest relatives have no idea what they do. It’s not because they’re spies or nuclear scientists, but because their jobs are so arcane: trying to reinvent Medicare to improve it, and maybe save taxpayers money.
In a sprawling, nondescript office park near Baltimore, some 360 people at the Center for Medicare & Medicaid Innovation are trying to change the health care system, using the government’s premier insurance program as leverage. If they prevail, the U.S. may no longer have the worst of both worlds: unsustainable spending and unenviable results.
“I want Medicare to exist not just for my mother, but for me and my kids,” said the director, Patrick Conway, 41, a pediatrician who also serves as Medicare’s chief medical officer.
At the center are doctors, lawyers, health policy experts, and career Medicare employees. Many came from outside government. They’re somewhat younger than Medicare’s core staff. Some have seen how parents and grandparents can be harmed in the nation’s disjointed health care system. The center’s physical layout is meant to encourage discussion and debate. Meeting rooms have walls you can write on to diagram ideas. Laptops are at every meeting, but for thinkers who like to have a toy in their hands to play with, there’s a cigar box with colorful dinosaurs in one conference room.
The innovation center can’t yet claim it’s saving Medicare from extinction. Its experiments have produced modest results that on balance are encouraging. The center is in its sixth year, and its influence is starting to be felt throughout Medicare in areas from joint replacement surgery to cancer treatment and front-line primary care, which remains a principal focus.
Medicare started out as an efficient bill-paying service that asked doctors and hospitals few questions. Lawmakers eventually realized that was a path to financial ruin, and they turned to blunt cuts that caused new problems. The idea now is to use Medicare payments to create financial incentives for doctors and hospitals to work together, helping patients avoid costly hospitalization whenever possible.
That might mean paying a primary-care practice to hire a clinical coordinator who keeps tabs on patients with chronic illnesses. It could mean holding hospitals accountable for the overall cost and quality of joint replacement surgery, to encourage attention to rehabilitation. Successful experiments can be adopted as permanent policy without seeking approval from Congress.
Because the center was created by President Barack Obama’s health care law, its future under a Republican president is questionable. But Republicans would be wise to keep the center running, said Mark McClellan, the Medicare chief under former President George W. Bush. “The authority to try out and then expand successful models of Medicare reform is a very useful capability,” he said. A Republican administration might do more to engage Medicare beneficiaries to bring about change, McClellan said. That could involve offering financial rewards for healthy behavior. Right now very few of Medicare’s 55 million beneficiaries have any idea that changes they’re starting to see are part of a deliberate effort to remake the traditional side of the program.