Examining the Medicare Care Management Performance Demonstration

Mathematica is evaluating the Medicare Care Management Performance (MCMP) demonstration, a congressionally mandated test of incentives to encourage physicians to improve the quality of care they provide to seniors and disabled beneficiaries with chronic conditions. The demonstration is aimed at physicians practicing in solo or small to medium-sized practices. The incentives take the form of "pay for performance." Doctors who meet or exceed performance standards established by the Centers for Medicare & Medicaid Services (CMS) receive bonus payments for managing the care of eligible Medicare beneficiaries. In its first year, the demonstration is a "pay-for-reporting" initiative to help physicians become familiar with the quality measurement process.

Mathematica's evaluation, funded by CMS, is assessing (1) implementation; (2) impacts on quality of care, continuity of care, Medicare costs, and beneficiary and physician satisfaction; and (3) the extent to which the effects of financial incentives depend on beneficiary and physician-practice characteristics. The demonstration is being implemented in four states in 2007—Arkansas, California, Massachusetts, and Utah. These states also served as the four pilot states for the Doctor's Office Quality-Information Technology project, which CMS implemented in conjunction with Quality Improvement Organizations to promote the adoption of electronic health record systems and information technology in small to medium-sized physician practices and to help enhance quality of care.

The evaluation involves case studies of 50 physician practices, surveys of nearly 5,000 Medicare beneficiaries and 1,600 physicians in both demonstration and comparison groups, and analysis of Medicare claims data and clinical measures. Reports will describe how physicians reorganized their practices to enhance quality of care and monitor Medicare costs over the life of the demonstration. A report to Congress is due one year after the end of the three-year demonstration.

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