Evaluation of the Extended Medicare Care Management for High-Cost Beneficiaries Demonstration

The Care Management for High Cost Beneficiaries (CMHCB) Demonstration, started in October 2005, provided disease management services for thousands of beneficiaries. The Centers for Medicare & Medicaid Services (CMS) awarded six organizations a 3-year demonstration project. The principal objective of this demonstration was to test a pay-for-performance contracting model and new intervention strategies for Medicare fee-for-service (FFS) beneficiaries, who are high-cost and who have complex chronic conditions; with the goals of reducing future costs, improving quality of care and quality of life, and improving beneficiary and provider satisfaction. CMS extended three of the original six demonstrations which showed sufficient promise of quality improvement and cost savings, under authority provided in Section 402 of Public Law 92-603 for a maximum of three years with annual renewals subject to quarterly financial evaluation of performance. This task order continues to study the design and implementation of the three extended programs and to evaluate the experience of the intervention group on each program compared to the relevant control group to ascertain the ability of each program and individual elements of each program to improve clinical quality, promote efficient use of health care services, and produce savings for Medicare in the intervention group. Under this contract the evaluator assisted CMS with the design features of the extended and expanded programs to assure that suitable control groups were identified. The evaluator also revised the design of the original evaluation plan to account for lessons learned in the execution of the original evaluation.