What You Won't Hear About in the Senate Bill

This past summer, I wrote an op ed in the Boston Globe entitled Retooling the Medicare/Medicaid Model.  In the piece, I discuss the enormous fragmentation and dysfunction that exists between the Medicare and Medicaid programs.  Although housed within one agency, these two gargantuan government programs are incredibly siloed and often work at cross purposes, thereby adding significant cost to the system.  This is seen most clearly in the so-called dual-eligible population -those high cost individuals who are on both programs.  Here is what I recommended: 

"The Obama administration can reorganize CMS so that it focuses as much on the unique needs of populations as it does on the rules of payment. CMS should create a program integration unit devoted exclusively to breaking down silos between the two programs and working with states to eliminate barriers to seamless care for dual eligibles. Doing so will go a long way to reducing costs - and free up resources for more far-reaching reform."

I was delighted to read recently that the Senate bill does just that.  Buried on page 517 of the bill, in section 2602, it establishes a Federal Coordinated Health Care Office within CMS for the purpose of, "bring[ing] together officers and employees of the Medicare and Medicaid programs at [CMS] in order to more effectively integrate benefits under [both programs] and . . .  improve the coordination between the Federal Government and States."

Hooray!  And the best part -- unlike the several-year delay of most major sections of the bill, this one will become effective in March, 2010.  You will not hear or read about this provision because it does not make for a good sound bite.  But this new Office - if it realizes even half of its promise -- will have a profound impact on improving care and reducing cost for some of the costliest individuals on our public programs.  So tell that to the next person who tells you that the bill will do nothing to bend the cost curve!  Please read my Op-Ed for more background.  And let's hope this provision makes it through conference.