PGP: Physician Group Practice or Pretty Grim Progress?

A recent Perspective in the New England Journal of Medicine by Gail Wilensky comments on the "sobering" results of the Physician Group Practice demonstration projects.  Dr. Wilensky references the full article and comments that while some disease metrics were improved, costs were rarely decreased, and patients were not kept out of the hospital/ER (which is why costs were not reduced).  At first blush, there should be at least some recognition that health outcomes were mildly improved for roughly the same cost increase as the control population.  That is to say, even if the care management programs were not the panacea that Medicare hoped, there was improvement.  That being said, I do not find it terribly shocking that these programs had such limited success.  We have seen time and time again that you cannot just wrap around a broken primary care system and except great results.