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Monitoring and Evaluating Medicaid Fee-for-Service Care Management Pro

Monitoring and Evaluating Medicaid Fee-for-Service Care Management Pro

Chapter 5. Conclusions and Future Implications

Evaluation can help policymakers determine whether their CM initiatives are achieving the intended goals, whether performance improvements are possible, and whether there are more efficient ways to achieve similar effects. This User's Guide provides practical guidance to State decisionmakers charged with developing, implementing, and evaluating CM programs. Because each State will be implementing its CM program in a unique environment with different goals and objectives, we have attempted to outline the steps necessary and tradeoffs to consider when designing and implementing an evaluation rather than recommending a specific evaluation design.

How States Have Used Their Evaluations

Evaluation results from States have had an enormous impact on changing the course of the program. We hope that this guide will enable you to use evaluation to maximize your investment in CM. For example, North Carolina's evaluation efforts demonstrated significant cost savings from their CM program.33 After the findings were presented to the legislature, the State doubled program enrollment in 2005, and in September 2006, the program became Statewide. North Carolina's CM program is now considered the State's principal vehicle for managing care.21

Washington State also shared its evaluation findings with the legislature. However, officials in Washington have found that their evaluation efforts have had the greatest impact on ongoing program management-identifying problem areas and opportunities for improvement. In particular, Washington has used its evaluation findings to improve CM vendor contracts and contract management.12

As many States gain experience with designing, implementing, and evaluating Medicaid fee-for-service CM programs, policymakers and researchers will gain a greater depth of understanding of whether, and how, CM works.

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Continued Evaluation Is Necessary for the Evolution of CM Programs

Like most of health care, CM programs are continuing to evolve to maximize benefits. Although CM programs were initially single-disease based, these programs are evolving away from disease-specific management to address the multiple and complex needs of patients. However, even as States refine and integrate their CM programs or shift their focus to other strategies for chronic care management, many of the principles of CM evaluation that are outlined in this guide will still be relevant.

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This guide could not have been produced without the assistance of a number of people. AHRQ and AcademyHealth acknowledge the Lewin Group and the AHRQ Care Management Learning Networks for ongoing collaboration and feedback. In particular, we acknowledge and appreciate the time and effort of the following individuals:

Ron Ackerman, MD, MPH
Assistant Professor of Medicine
Affiliated Scientist of the Regenstrief Institute
Indiana University School of Medicine

Melanie Bella, MBA
Senior Vice President
Center for Health Care Strategies

Randall Brown, PhD
Vice President and Director of Health Research
Mathematica Policy Research, Inc.

Don Fetterolf, MD, MBA
Corporate Vice President
Health Intelligence
Matria Healthcare, Inc.

Denise Levis Hewson, RN, BSN, MSPH
Director of Quality Improvement and Clinical Operations
Community Care of North Carolina

Thomas Inui, MD
President & CEO
Regenstreif Institute

Jeanette May, PhD
Director of Research
Disease Management Association of America

Jean Moody-Williams, RN, MPP
Director, Division of Quality, Evaluation and Health Outcomes
Centers for Medicare & Medicaid Services

Marc B. Rosenman, MD
Research Scientist
Regenstrief Institute
Assistant Professor Pediatrics
Indiana University School of Medicine

Thomas W. Wilson, PhD, DrPH
Founder and Board Chair
Population Health Impact (PHI) Institute

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Page last reviewed November 2007
Internet Citation: Monitoring and Evaluating Medicaid Fee-for-Service Care Management Pro: Monitoring and Evaluating Medicaid Fee-for-Service Care Management Pro. November 2007. Agency for Healthcare Research and Quality, Rockville, MD.