Get Updates
Mathematica Team Cited for High-Impact Research
Contact: Cheryl Pedersen, (609) 275-2258
PRINCETON, N.J. (February 3, 2009)—A study conducted by Mathematica Policy Research, Inc., has been named winner of the Health Services Research Impact Award for 2009. AcademyHealth, a nonprofit public policy organization, announced the award, which recognizes outstanding examples of the positive impact of research on health policy or practice, at its National Health Policy Conference on February 2.
The study team was led by Randall Brown, principal investigator on the Evaluation of Three Cash & Counseling Programs, a three-state demonstration that tested an innovative form of expanded consumer direction for Medicaid beneficiaries who are frail or have disabilities. These individuals received a monthly cash allowance to purchase personal assistance and related goods. They also received counseling to help plan these purchases. They could purchase personal assistance, which includes help with activities such as bathing, dressing, and preparing meals, from family members, friends, or others of their choosing, rather than traditional home care agencies. They could also use the funds to purchase assistive devices or make home or vehicle modifications to support their ability to live independently. The primary goal was to increase consumers’ control over personal care, enhancing satisfaction and reducing unmet needs without increasing public costs.
In addition to increasing beneficiaries’ control over and satisfaction with personal care by letting them choose what services they wanted, who provided them, and how and when they were provided, Cash & Counseling sought to reduce the burden of unpaid family caregivers. Cash & Counseling was tested in Arkansas, Florida, and New Jersey. The research team randomly assigned consumers who volunteered for the study to either the participant group or a control group that would get services as usual. Comparison of outcomes for these two groups led to rigorous, robust estimates of the program’s effects.
The researchers found that participants in all three states were much more satisfied with the care they received and their quality of life than the control group. More than half said that the program improved their lives a great deal. They also experienced no more adverse health events than the control group— key initial concern of some policymakers—and for some measures had significantly lower rates of adverse events. Unpaid caregivers, mostly family members of the participants, reported significantly less financial, physical, and emotional stress and greater satisfaction with life than the control group’s caregivers. In one of the study states, use of nursing homes by participants was reduced by 18 percent. Across all three states, the treatment group reported no more instances of adverse health events related to caregiving than the control group. Workers hired under the program also reported positive effects: higher satisfaction with the pay they received, and similar rates of job-related injuries or physical strain than agency workers serving the control group.
Brown, a vice president and director of Mathematica’s health research in New Jersey, said, “For years, policymakers have searched for interventions that help frail people and those with disabilities remain in the community. This study showed that you can do it simply by letting them, and their families, decide how to best meet their needs. Conducting this study was incredibly rewarding. It’s a great feeling to provide hard evidence that vulnerable people’s lives can be greatly improved simply by letting them make their own decisions, with minimal oversight, about how public money is spent on their care. Equally important is the fact that family caregivers’ lives improved so much. Policymakers owe a great debt to the Robert Wood Johnson Foundation and the Office of the Assistant Secretary for Planning and Evaluation for funding this study, and to the national Cash & Counseling Program Office for guiding the states so effectively in implementing the program.”
Kevin J. Mahoney, who served as director of the national Cash & Counseling program office at Boston College, added, “There is no doubt that the Cash & Counseling model for providing personal assistance services can help states better serve Medicaid participants and improve their lives. We congratulate Mathematica on this important award.” Mahoney currently leads the National Resource Center for Participant-Directed Services, the only national center of its kind focused on supporting states and organizations, regardless of funding source, that want to offer—or are already offering—participant-directed care services to people of all ages with all types of disabilities. The center builds on the lessons learned from the successful Cash & Counseling program.
In recognizing the work of Brown and the Mathematica evaluation team, which included co-authors Barbara Carlson, Stacy Dale, Leslie Foster, Barbara Phillips, and Jennifer Schore, AcademyHealth noted that the evaluation assured policymakers that this type of consumer-directed care is safe and capable of controlling program costs. As a result, changes to improve the lives of many Medicaid beneficiaries and their caregivers have been enacted. For example, Congress amended the Deficit Reduction Act of 2005 to permit states to offer Cash & Counseling without burdensome waivers. The revised law also provided incentives to use the program model to transition nursing home residents into the community. In addition, the Centers for Medicare & Medicaid Services has proposed a rule to permit more beneficiaries around the country to direct their personal assistance services. Twelve more states have adopted similar Cash & Counseling programs, and a number of other states are developing similar alternatives to traditional services.
The study was funded by the Robert Wood Johnson Foundation (RWJF) and the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE). Pamela Doty at ASPE was the federal project officer for the evaluation; Nancy Fishman was the project officer for RWJF. A special issue of Health Services Research includes 10 papers on the program’s origins, implementation, and dissemination, as well as impacts on consumers, caregivers, and costs. An article in Medical Care focuses on the Arkansas program’s reductions in nursing home use over three years.
About Mathematica®
Mathematica, a nonpartisan research firm, conducts high-quality, objective policy research and surveys to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J.; Washington, D.C.; Cambridge, Mass.; Ann Arbor, Mich.; and Oakland, Calif., has conducted some of the most important studies of health care, education, welfare, employment, nutrition, and early childhood policies and programs in the United States.
About the National Resource Center for Participant-Directed Services:
The National Resource Center for Participant-Directed Services will provide technical assistance, training, research, and policy analysis to states and other organizations with the goal of improving the lives of people of all ages with all types of disabilities and who want to maintain their independence and direct their own services and supports. The center is funded by a $4.75 million grant from the Robert Wood Johnson Foundation, a $3.5 million grant from the Atlantic Philanthropies, and additional support from the U.S. Administration on Aging and the Office of the Assistant Secretary for Planning and Evaluation. For more information, please visit www.cashandcounseling.org.