Evaluation of Programs of Coordinated Care and Disease Management

Mathematica Policy Research, Inc. (MPR) evaluated 16 independent demonstration sites that
provide coordinated care interventions to Medicare beneficiaries with chronic illnesses. The
rationale for the demonstration is the lack of coordination among the multiple providers
typically serving Medicare beneficiaries with chronic illnesses, as well as the adverse
consequences of the lack of coordination for the beneficiaries and for Medicare costs. The
demonstration sites, selected in early 2001, offered programs designed to improve both the
care that patients receive and patients' knowledge of, and adherence with, recommended
self-care and behavior. The study estimated the effects of each site on patients' well-being
and satisfaction, in addition to the site's effects on the use and cost of Medicare covered
services. This analysis relied on a patient survey conducted 6 to 12 months after
enrollment, and on Medicare claims data and any data available from the demonstration sites
that could enhance the study. The study included two rounds of physician surveys. In each
site, eligible applicants were randomly assigned to treatment and control groups. An
extensive process analysis was conducted to describe the interventions in detail, with the
key goal being an assessment of those factors that account for program success and failure.
The study included case studies of each site, program profiles, interim site-specific memos,
two interim summary reports, two reports to Congress (based on the interim summary reports),
and a final summary report. This original study enrolled 18,277 beneficiaries.

In 2008 Congress extended the study for 2 of the sites, Mercy Medical Center - North Iowa
and Health Quality Partners in Pennsylvania, and they will recruit beneficiaries and provide
demonstration intervention services through the spring of 2010. Mathematica Policy Research
will evaluate the results of this extended demonstration using Medicare claims data and
qualitative site visits to the two programs.

Inclusion Criteria:

- Meets clinical and prior health service use criteria of each of the 16 demonstration
sites (vary across demonstration programs)

- Resides in catchment area of one of the programs

- Enrolled in Medicare fee-for-service program

- Coverage by both Medicare Parts A and B

- Medicare is primary payer

Exclusion Criteria:

- Does not meet any of the relevant program's exclusion criteria (vary across
demonstration programs)

- Not enrolled in a Medicare Advantage plan (Medicare managed care program)