Monitoring and Evaluating Medicaid Fee-for-Service Care Management Programs User Guideby Sharon Arnold
Across the country, a wide range of care management (CM) initiatives are underway in Medicaid programs. These initiatives seek to reduce costs and improve the quality of care for individuals with chronic conditions. The Centers for Medicare & Medicaid Services (CMS), private vendors, States, and others are undertaking evaluations to determine whether CM programs will… See more details below
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Across the country, a wide range of care management (CM) initiatives are underway in Medicaid programs. These initiatives seek to reduce costs and improve the quality of care for individuals with chronic conditions. The Centers for Medicare & Medicaid Services (CMS), private vendors, States, and others are undertaking evaluations to determine whether CM programs will lead to cost savings.
With so much activity in this arena and a high degree of variability among care management programs, States and others are interested in understanding how to weigh the evidence presented by vendors and relate it to the array of program designs being offered. In particular, a clearer understanding of methodologies and issues related to evaluating the costs and quality of these programs will help States to assess the impact of their CM initiatives.
This guide walks through the steps necessary for evaluating a Medicaid CM program to assess the economic and quality impact of CM interventions. From how to get started, to thinking about the budget, to executing the evaluation itself, this user's guide is a resource through each stage of the evaluation process. Sections contain background information, State examples, checklists, and charts to help you answer your evaluation questions and make sense of the process.
The guide moves beyond "one size fits all," providing information and perspective on the benefits of specific designs for specific situations. In this way, it can be a resource to States as they create their CM programs or negotiate evaluation methods during CM vendor contracting and reconciliation. In addition, the guide can assist States in critically reviewing other evaluation findings, including published articles and data reported by CM vendors in their proposals and marketing materials.
The guide will be especially useful for decisionmakers and others involved with designing CM programs and overseeing their evaluation. These include directors of Medicaid care management programs, quality improvement directors, contract negotiators, program analysts, Medicaid medical directors, and program evaluators. The guide includes a section that can be used to educate higher level policymakers (e.g., legislators, cabinet secretaries, governors' budget directors) about the importance of evaluating CM programs and how their decisions can impact the viability of these evaluations.
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