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The Center for Medicare and Medicaid Innovation (CMMI) has come under increased political scrutiny for its demonstration programs’ frequent failure to produce savings for Medicare and Medicaid. These failures are surprising given that many demonstration projects are designed around care interventions that have evidence of achieving savings and reducing avoidable health care use.
It’s important to understand what is driving these disappointments. And it’s not just policy makers who need to explain why interventions might create savings in pilots but fail to do so at scale. Any provider of value-based care (VBC) attempting to scale their own programs must account for potential obstacles to future expansion and growth.
To that end, with this article I examine mixed results from the now-terminated Medicare Independence at Home (IAH) Demonstration project. I consider why an evidence-based care intervention may fail to achieve expected savings in a new setting—and what policy makers and operators should do about it.