Evaluating the Economic and Clinical Impact of the Commonwealth Care Alliance Model for Disadvantaged Populations

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The Commonwealth Care Alliance (CCA) of Massachusetts has developed two care delivery models to curb spending growth while improving quality: 1) One Care, a demonstration project targeting individuals under age 65 who are dually eligible for Medicare and Medicaid; and 2) Senior Care Options, a special-needs plan for people age 65 and older who are either dually eligible or Medicaid-eligible only. CCA bears financial risk for its members' health care spending and pays for the entire continuum of care, including medical, behavioral health, long-term services and supports, pharmaceuticals, and social services, from a capitated budget. Since 2012, CCA has been a participant in the Fund-supported project Promoting Integrated Care for Dual Eligibles (PRIDE), which has examined successes and challenges in providing efficient, integrated care for dual-eligible populations. Results of CCA's interventions presented at a recent PRIDE meeting inspired the idea to support a formal evaluation. A team of investigators from Harvard Medical School, the University of Massachusetts Boston, and University of Massachusetts Medical School will evaluate the impact of the CCA model on key economic and health outcomes. Analyzing claims data from two years prior to the CCA interventions and two years following the intervention, the team will evaluate changes in health care spending, utilization, and quality for CCA patients compared to matched comparison groups of patients. The team will conduct a qualitative study of patients, providers, and CCA staff to develop a detailed understanding of the model's mechanisms and impact. The research team has deep expertise in program evaluation, including quality of care and outcomes for high-need populations, as well as experience working with Massachusetts Medicaid data and the state's all-payer database. Fund staff is working with senior researcher David Grabowski to ensure the study is adequately powered to detect true differences in outcomes. We have build into the grant an initial contingency whereby the evaluation will not proceed until the sample has been reviewed and deemed acceptable. This research will expand the evidence base that policymakers need to develop and implement effective delivery models for high-need, high-cost populations, including frail elders, people with complex health conditions, and nonelderly adults with disabilities. The results could also shed light on program components important to bringing such models to scale.

Grant Details

Grantee Organization:
President and Fellows of Harvard College
Principal Investigator:
David Grabowski, Ph.D.
Award Amount:
$346,077.00
Approval Date:
November 14, 2017

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