Most Medicare demonstrations to enhance health care quality and improve efficiency have not reduced Medicare spending, according to a new report by the Congressional Budget Office.

The report reviews outcomes from six disease management/care coordination demonstrations and four value-based payment demonstrations. The disease management/care coordination demonstrations comprised 34 programs operated by disease management companies, which on average "had little or no effect on hospital admissions or regular Medicare spending," CBO said.

The only value-based payment demonstration to yield significant savings was the Medicare Participating Heart Bypass Center, CBO said. The Physician Group Practice and Premier Hospital Quality Incentive value-based payment demonstrations "slightly improved quality of care based on the measures adopted," while preliminary results from the Home Health Pay-for-Performance demonstration suggest it "had little or no effect on Medicare spending or quality of care in the first year," CBO said.

The report concludes "that substantial changes to payment and delivery systems will probably be necessary for programs involving disease management and care coordination or value-based payment to significantly reduce spending and either maintain or improve the quality of care provided to patients."