Improving the Quality and Efficiency of the Medicare Program Through Coverage Policy (August 2011)

This issue brief focuses on the role of payers in achieving Medicare's "triple aim" of improving the care experience, improving health, and reducing costs. It is a collaborative effort from CMTP and the Urban Institute.

CMTP collaborated with Robert Berenson of the Urban Institute to develop an Issue Brief on “triple aim” of the Medicare program to (1) improve the individual experience of care, (2) improve the health of populations, and (3) reduce per capita costs of care for populations. While much of the focus of the Triple Aim has been on providers of health services, there is a role for payers also.  Medicare coverage determinations “can act as a policy lever to influence both the appropriate use of medical technology and the creation of better evidence to support clinical and health policy decisions.”

The authors describe how, in the current medical technology marketplace, new technologies are often adopted with little evidence that they represent any improvement over existing technologies, and with scant evidence of whom the new technology might benefit or harm. Meanwhile, due to a range of factors (including the structure of Medicare decision-making system, statutory language, fiscal and political pressures) CMS coverage determinations fall short of achieving the goals of the triple aim. Following an analysis of the barriers to more effective decision-making, the authors offer a series of timely and bold proposals for operational and policy changes calibrated to improve CMS’s ability to promote better evidence for new technologies which in turn can improve health and care.  This paper was produced with support from the Robert Wood Johnson Foundation in August 2011.