Five Projects that Could Contain Costs in Health Reform

These participating companies would, by contract, allow an independent monitor to "conduct periodic reviews and prepare root-cause quality and deficiency analyses of a chain to assess if facilities of the chain are in compliance with applicable laws. The reviews would be published.

• Independence at Home Demonstration Program. This project would test a way of rewarding physician, nurse practitioner, and pharmacist teams to visit the homes of severely ill patients with chronic diseases on a 24/7 basis. The goal would be to improve health outcomes and keep patients from rushing to the emergency room.

The teams would be paid a set rate per beneficiary, but would be rewarded with any savings they achieve, not unlike a capitated model.

Those teams selected for such a pilot demonstration project would also use electronic health information systems and remote monitoring, as well as mobile diagnostic technology, all of which can function more efficiently and less expensively than the traditional acute care setting.

Though these five programs are in the latest House health reform bill, many critics have charged there still isn't enough concrete cost savings in the legislation. Plus, many questions remain:

• If the bill passes with these proposals intact, which will be picked for these short-run demonstration projects?


• Who will decide if they actually work?


• How much will it cost to test them and will those involved be strong enough to admit when they have failed?


• If the projects do work, how can they be effectively expanded, and who will have the authority to decide?