Could we shift low value spending to high value spending in Medicare?

This is really the big question behind the notion that value (defined as benefits of care greater than costs for patient) could be increased in the Medicare program while overall costs stay the same or decrease. This may sound too good to be true, and might be, but I think the best chance to pull this off is for Medicare to expand their covered benefits to include long term care. I outline the idea in this Health Affairs post (study referred to in the post).

The comments I have gotten (and that are left on the post) are roughly of two types:

  • great idea, LTC is such an important issue! Most of these folks have personal experience with our LTC system
  • you nut, Medicare is insolvent now and you want to add a new entitlement + unicorns don’t exist

The you are a nut response always has a chance of being correct, and this does sound too good to be true. And I am saying we can shift spending from low value, to high value care; I am not saying lets simply add more benefits on top of everything else. Why I think it might be possible in three simple bullets.

  • we spend so much on medical care that doesn’t help patients (so is low value)
  • LTC is such a tremendous need, and funding more of this will be high value (benefits > costs for patients)
  • If patients have broader options, including flexible LTC, many will choose a path that has less low value care (therefore shifting low value spending to higher value spending)

Pessimism is always warranted. But, this is my story and I’m sticking to it. The best way to increase the value of Medicare spending, is to expand coverage of LTC.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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