Three Mathematica Studies Featured in the June Issue of Health Affairs
Contact: Jennifer de Vallance, (202) 484-4692
WASHINGTON, DC—June 5, 2012—People with chronic illnesses or disabilities tend to be among the highest-need beneficiaries of Medicare and Medicaid, accounting for a disproportionate amount of spending across both programs. Three studies on this topic, led by researchers at Mathematica, are featured in the June 2012 issue of Health Affairs, as the journal addresses payment and care models for treating elderly and disabled people.
One study, by Mathematica’s Marsha Gold and colleagues from the Kaiser Family Foundation, focuses on state efforts to coordinate care for “dual eligibles”—Americans covered by both Medicare and Medicaid—within an integrated plan. The study revealed that (1) most beneficiaries currently receive Medicare and Medicaid benefits separately through fee-for-service arrangements, and (2) states have only a patchwork of experience with program coordination and integration for this population. The authors also found major gaps in timely, publicly available data relevant to assessing enrollment in initiatives designed to improve care, outcomes, and program efficiency for dual eligibles.
Another study, led by Randall Brown and colleagues at Mathematica, identifies a high-risk subgroup of Medicare beneficiaries in the Medicare Coordinated Care Demonstration for which 4 of the 11 participating programs significantly reduced hospitalizations, and the distinguishing features of those successful programs. Frequent in-person contact (in addition to telephone contact) by care coordinators with patients and their providers, robust medication management, and comprehensive transitional care when patients are hospitalized were among six features common to the four programs that reduced hospitalizations for high-risk beneficiaries. These features were generally missing from the demonstration programs that did not reduce hospitalizations. If combined with modest coordination fees and cost-effective delivery methods, these interventions could generate a net Medicare savings for high-cost beneficiaries, who represent 18 percent of all Medicare beneficiaries and account for 37 percent of Medicare costs.
A third study was led by Mathematica’s Deborah Peikes and colleagues at Mathematica and at the Washington University School of Medicine in St. Louis. The authors analyzed the experiences of the School of Medicine’s care-management program as it took part in the Medicare Coordinated Care Demonstration, with the goal of reducing hospitalizations and Medicare spending or improving quality while remaining cost neutral. The study showed that changes made to the intervention transformed a program that had increased total costs 12 percent to one that achieved cost neutrality for all chronically ill enrollees. These changes included comprehensive medication management and transitional care, more in-person contact by care coordinators with both patients and providers (while still mainly using phone contact), and more systematic patient assessments to identify unmet needs or barriers to following care plans. Savings were driven by 55 percent of enrollees who were high risk; implementing these changes saved Medicare 10 percent for these patients. The study demonstrates the importance of delivering the right services to the right people.
About Mathematica: Mathematica Policy Research seeks to improve public well-being by conducting studies and assisting clients with program evaluation and policy research, survey design and data collection, research assessment and interpretation and program performance/data management. Its clients include foundations, federal and state governments and private-sector and international organizations. The employee-owned company, with offices in Princeton, NJ; Ann Arbor, MI; Cambridge, MA; Chicago, IL; Oakland, CA; and Washington, DC; has conducted some of the most important studies of health care, nutrition, education, international, disability, family support, employment, and early childhood policies and programs.