Next steps: how can Medicare accelerate the pace of improving chronic care?

David Bott and colleagues report little success so far in demonstrations and pilot programs undertaken since 1999 to improve chronic disease management in the traditional Medicare program. The findings presented are highly generalized. To accelerate learning and progress, the Centers for Medicare and Medicaid Services (CMS) should expedite release of program-specific evaluations and data for external review. In addition, experience from the quality improvement field suggests that a new approach to program development would be beneficial, featuring intensified collaboration and data exchange to facilitate rapid program improvement, and application of a broader set of scientific methods than are used in clinical trials to gauge results.