Blood, sweat, and billions have gone toward studying whether different care delivery models can improve health outcomes of the chronically ill while holding down costs. A recent set of Medicare disease management pilot programs with these twin goals showed, at best, uneven results. As previously noted in this space, only three, including a promising one in Pennsylvania, have been extended beyond their initial periods. Even these programs did no yet reduce overall costs of care for the chronically ill. The key word in that last sentence is "yet."

We must not be fickle in funding delivery system innovation. Politicians and the general public have microscopic attention spans and wildly unrealistic expectations as to how quickly new health care programs can fulfill their promise. This is particularly problematic for innovations that deal with the management of chronic diseases. The problem is compounded when patients are poor, uninsured or underinsured and suffer from illnesses that were undertreated if they were treated at all. As detailed below, the state of California is discovering this at the outset of a major public investment in pilot programs focused on these populations.

Beyond questions of effective long-term stewardship of scarce public resources, there are real human costs to short-lived serial infatuation with new pilot programs. We nearly all believe that a real and ongoing relationship between patient and provider is paramount to quality medical care, yet we often reshuffle which federal program people qualify for and what care facilities they can access. Ideally patients should have some stability and consistency of access points, particularly within a system that can seem byzantine and impenetrable even to those who study health policy for a living.

One group in great need of stability and consistency is the low-income uninsured and underinsured. The California Coverage Initiative is a series of pilot programs designed to serve this population. The initiative relies on $180 million in matching federal funds from a waiver that California negotiated with the federal government as a part of its ongoing state Medicaid allocation. San Mateo, one of 10 counties that received funding, has developed an “Innovative Care Clinic” at the San Mateo Medical Center.

The ICC is a “radical redesign” of the Main Campus Adult Primary Care Clinic, which provides about 20,000 visits per year to a low-income uninsured and underinsured population. The ICC is the very model of a modern major facility designed to provide effective chronic disease management. It leverages the latest innovations in team-based care, coordination of medical and social support, and medication management.

Its recently-initiated operations will be evaluated by a “Rapid Evaluation Performance System” created by the UCLA School of Public Health. The quick turnaround in assessing the impact of these innovations is necessary because the funding for the pilot program expires in three years. However, this short-term focus on the impact of this new system of coordinated care delivery may not reveal the true promise of the program. Simply put, three years may not be enough.

Many of the hundreds of patients who are streaming into the center suffer from chronic diseases that have remained untreated or poorly treated for years. Hence the upfront costs of providing for care may be higher in the initial years. It is only through creating a stable medical delivery system—the fertile ground in which real relationships between providers and patients can germinate—that we will eventually see the improved health outcomes and cost savings associated with effective chronic disease management. Organizations such as Kaiser Permanente have devoted many years and many hundreds of millions of dollars into putting disease management systems in place for their members and have seen only modest reductions in relative costs. And Kaiser’s members generally have better health profiles and more developed support networks than California’s uninsured residents.

Will the public have the stomach for the upfront costs of putting better chronic disease management systems in place? In this fiscal environment, can we guarantee stable revenue streams to support these pilots long enough to see whether they reach their destinations? If we have a failure of will, if we insist on immediate results, we will never know what promise these new systems may have held. We will continue to lurch from fad to fad, bringing people in desperate need of medical care into the friendly confines of innovative public institutions, just to slam these doors closed right as they are beginning to truly improve health outcomes. That’s neither good financial management nor good medicine.