Strategies for Reining in Medicare Spending Through Delivery System Reforms: Assessing the Evidence and Opportunities.

This paper reviews proposed reforms to strengthen Medicare’s long-term fiscal outlook. Looking beyond provider payment reductions, the author assesses leading strategies to improve quality of care and efficiency within Medicare as well as the overall health care system. The paper argues that many of the most prominent proposed reforms are not likely to achieve savings for Medicare in the next 10 years, but identifies approaches that hold real promise for generating savings by either reducing chronically ill beneficiaries’ need for expensive services or changing providers’ practices in ways that decrease unnecessary procedures and inefficiencies. A companion paper synthesizes evidence on cost-effective interventions, identifies issues to resolve for ongoing research, and recommends care coordination policies supported by available evidence.