Health Topics

• Data Development
• Health Care Reform
• Health Information Technology
• Medicaid and CHIP
• Medicare
• Mental Health and Substance Abuse
• Payment Policies and Costs
• Public and Population Health
• Quality and Health System Functioning
• State Health Policy

Examining the Medicare Care Management Performance Demonstration

Mathematica is evaluating the Medicare Care Management Performance (MCMP) demonstration, a congressionally mandated test of pay-for-performance incentives to encourage physicians to improve the quality of care they provide to eligible fee-for-service Medicare beneficiaries and foster the implementation and use of health information technology. The three-year demonstration, which started in July 2007, is aimed at physicians in solo or small to medium-sized practices.

Under the demonstration, physician practices that meet or exceed performance standards established by the Centers for Medicare & Medicaid Services (CMS) in clinical performance process and outcome measures will receive a bonus payment for managing the care of eligible Medicare beneficiaries. Practices that submit performance data electronically using a certified electronic health record (EHR) system will also be eligible for a larger incentive payment. The bonuses are in addition to the normal fee-for-service Medicare payment received for services delivered.

Mathematica's evaluation is assessing (1) implementation; (2) impacts on quality of care, continuity of care, Medicare costs, and beneficiary and physician satisfaction; and (3) the extent to which the effects of financial incentives depend on physician-practice characteristics, including the use of health information technology. The demonstration is being implemented in four states—Arkansas, California, Massachusetts, and Utah. The evaluation relies on a quasi-experimental design (matched comparison group) to assess the impacts of financial incentives on outcomes.

The evaluation involves case studies of 40 physician practices, surveys of nearly 4,800 Medicare beneficiaries and 1,600 physicians in both demonstration and comparison groups, and analysis of Medicare claims data, clinical measures, and CMS's Office Systems Survey data. Reports will describe how physicians reorganized their practices to enhance quality of care, monitor Medicare costs over the life of the demonstration, and summarize the implications of findings to pay-for-performance programs, as well as programs to adopt health information technology in physician practices. A report to Congress is due in summer 2011.

Publications

"Using Payment Incentives to Improve Care for the Chronically Ill in Medicare: First Year Implementation of the Medicare Care Management Performance Demonstration (MCMP)" (March 2009)