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MEDICINE AND PUBLIC ISSUES

Moving beyond Round Pegs and Square Holes: Restructuring Medicare To Improve Chronic Care

Jennifer L. Wolff, PhD, and Chad Boult, MD, MPH, MBA

20 September 2005 | Volume 143 Issue 6 | Pages 439-445

Chronic disease is the norm rather than the exception among Medicare beneficiaries, yet Medicare's benefit structure and reimbursement mechanisms are poorly aligned with high-quality chronic care. This disconnect is thought to undermine the quality of chronic care, thereby contributing to excess program spending and placing beneficiaries at risk for undesirable health outcomes. Despite widespread recognition of this mismatch, there is little compelling evidence to suggest that successful quality improvement initiatives would reduce the costs of the Medicare program. This paper describes state-of-the-art chronic care innovations to date, discusses ongoing and planned efforts by the Centers for Medicare & Medicaid Services to test related changes to Medicare's benefit structure and provider reimbursement, and suggests opportunities for future progress in this area.

Author and Article Information

From the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University School of Medicine, Baltimore, Maryland.

Note: Portions of this article were based on a presentation by Jennifer L. Wolff at the American Geriatrics Society Conference "Research Agenda for Comorbid Disease and Multiple Morbidity in an Aging Society" on 4 March 2005. Our title is an adaptation of Bruce Vladeck's April 2002 report "Round Pegs and Square Holes: Medicare and Chronic Care," published by the National Academy of Social Insurance.

Acknowledgments: The authors thank Gerard Anderson and Antonio Wolff for their assistance with the manuscript.

Grant Support: None.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jennifer L. Wolff, PhD, Department of Health Policy and Management, Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 692, Baltimore, MD 21205; e-mail, jwolff{at}jhsph.edu.

Current Author Addresses: Drs. Wolff and Boult: Johns Hopkins University, 624 North Broadway, Room 692, Baltimore, MD 21205.

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