Progress Together: Mathematica Supports Improvement in Health Care Quality, Cancer Care, and Value-Based Care in New Projects with CMS

Progress Together: Mathematica Supports Improvement in Health Care Quality, Cancer Care, and Value-Based Care in New Projects with CMS

Apr 13, 2021
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Mathematica is pleased to announce recent contracts that build and expand our portfolio of health projects that contribute to our mission. Mathematica seeks to improve public well-being by conducting innovative policy research, cutting-edge data collection, and data analysis that meet the highest standards of quality and objectivity. The contract work will help decision makers across public and private sectors improve the evidence base in health care and quality.

Accelerating the transition to value-based care through peer-to-peer learning

The Center for Medicare & Medicaid Innovation (the Innovation Center) recently awarded Mathematica and its partners—Premier Inc., the Institute for Healthcare Improvement, and L&M Policy Research—a contract to operate learning systems for participants in the new Direct Contracting and Kidney Care Choices Models as well as the Medicare Shared Savings Program. All three of these value-based care initiatives offer participants an opportunity to receive shared savings if they achieve certain cost and quality benchmarks. Participants include integrated delivery systems, independent practice associations, dialysis organizations, and other types of health care organizations.

The new Value Based Care learning system creates a structure for peer-to-peer learning and the rapid dissemination of innovative ideas to support the Centers for Medicare & Medicaid Services (CMS) in achieving the models’ aims of reducing costs while improving quality and beneficiary experience. Mathematica will collaborate with the Innovation Center to do the following:

  • Convene various virtual and in-person learning events, such as webinars, affinity groups, and conferences.
  • Provide targeted technical assistance on implementing benefit enhancements and using data to support performance improvement.
  • Develop toolkits, case studies, and journal articles for public release.

Mathematica will work with the Innovation Center to design the curriculum in an iterative and agile way, using feedback from model participants to respond to emerging learning needs and policy issues.

Developing an out-of-home placement measure to support children

Mathematica is also supporting the Innovation Center by developing a measure of out-of-home placement (OOHP) for use in the Integrated Care for Kids (InCK) Model. The InCK Model aims to improve the well-being of children in Medicaid and the Children’s Health Insurance Program by identifying physical health, behavioral health, and social needs early; developing systems that coordinate care and integrating data across sectors to address children’s needs; and developing state-specific alternative payment models to support accountability for outcomes. Eight InCK awardees in seven states (Connecticut, Illinois, New York, New Jersey, North Carolina, Ohio, and Oregon) will develop approaches to integrating service delivery across behavioral health, physical health, and other child services, including child welfare and juvenile justice. The InCK Model’s primary goals are to reduce avoidable inpatient and emergency department care, Medicaid spending, and avoidable OOHP.

InCK defines OOHP as placement in a psychiatric hospital, residential care center, skilled nursing facility, correctional facility, foster care (including group homes and therapeutic foster care), or juvenile detention. By selecting OOHP as a primary outcome, the Innovation Center is responding to several chronic and new public health crises affecting the well-being of children, including rising rates of mental health conditions among children and adolescents, substance use epidemics for youth and adults, increasing placement of children and youth in foster care, a growing number of children with complex chronic conditions, and the COVID-19 pandemic. The OOHP measure developed under this task order will be used for program monitoring and in the InCK impact evaluation. Data sources include administrative data from Transformed Medicaid Statistical Information System Analytic Files and from child welfare and juvenile justice agencies.

Supporting implementation of a new radiation oncology model

In September 2020, CMS selected Mathematica and its partners Analytica, RTI International, and Vytal Solutions, to support the implementation of a new Innovation Center model expected to reduce costs and improve the quality of care for cancer patients receiving radiotherapy. The new Radiation Oncology (RO) Model aims to reduce Medicare expenditures through bundled payments that enable providers to focus on delivering high quality treatments. It promotes value-based care by creating simpler, more predictable payments that incentivize cost-efficient and clinically effective treatments to improve quality and outcomes. The RO Model, part of a final rule on specialty care models issued by CMS, is expected to begin on January 1, 2022, and is estimated to save Medicare $230 million over five years.

Mathematica’s work will include implementing a site-neutral, episode-based payment policy for radiotherapy services that is designed to benefit providers and patients. Site-neutral payments will establish a common payment amount that could be used to pay for the services regardless of where they are furnished. This approach gives radiotherapy providers more certainty regarding how these services would be paid. It will also test whether replacing the current fee-for-service payments with episode-based payments incentivizes physicians to deliver radiotherapy services that offers patients the best value in cost and quality. Mathematica will also build a knowledge management infrastructure, provide technical assistance, and establish a learning community. The learning community will support model participants in onboarding, provide information on model requirements, and enable participants to learn from subject matter experts and their peers to address participant learning needs. In addition, the team will identify, test, and support reporting of quality measures that will be used to assess whether the model is meeting its aims. It will also collect data on patient experiences with the model and provide feedback reports to model participants. Finally, the team will monitor participants to confirm that they are meeting requirements and monitor beneficiary experiences.

“The RO Model is CMS’s next big step in using prospective episode-based payments to encourage providers to deliver the right amount of treatment in the best setting for the patient,” said Jonathan Morse, senior vice president of health program improvement at Mathematica. “We are excited to continue to support both CMS and providers with movement toward episode payments in this exciting new model.”

To learn more about Mathematica’s work at CMS, contact Candace Natoli, director of health program improvement at Mathematica.