Unfortunately, contrary to the optimistic position you mention that letting more diverse models bloom, the better to test the concept, CMS’s track record would suggest that these demonstration projects will lack the capacity, data, or statistical power for sophisticated cross project comparisons.

Moreover, I think it is frankly outrageous that after the Coordinated Care Demonstration died its quiet death, and Medicare Health Support (nee CCIP) died its louder death, that health policy makers, CMS, and the health care establishment continue to act as if any model created by anybody with or without a track record in the care of complex older adults, has an equal chance of getting it right.

Our overwhelming experience in the last 20 years is been of failure – either demonstrations have fallen apart or, when well conducted, the models have failed to produce promised outcomes or both. A handful of carefully tested and successful models have been developed within the geriatrics community (e.g., Guided Care, Care Management Plus, IMPACT, GRACE) as described in Tom Bodenheimer’s perspective in NEJM http://content.nejm.org/cgi/reprint/361/16/1521.pdf

We need to pay more attention to geriatrics expertise when re-designing care for complex multiply co-morbid older Americans and stop pretending that anybody can be successful in meeting these challenges.