Cost Containment and the Tale of Care Coordination

The notion that care coordination not only improves outcomes but also lowers costs is not evidence-based, and it poses many potential dangers, beginning with the diminution of the importance of coordinated care itself as a worthy goal. Nobody likes waste or fragmentation. Evidence that both are hallmarks of the U.S. health care system has fueled debate over how to redesign payment and delivery systems to root out inefficiencies. In the face of broader imperatives of cost containment and quality improvement, a narrative has emerged from this debate that now dominates policy: care coordination not only improves outcomes but lowers costs, too. Though attractive, this notion is not evidence-based. Studies of programs or practice models designed to enhance coordination and management of care for patients with multiple conditions and multiple providers have shown minimal, if any, consistent savings. . . .