Projects

Lessons Learned from Evaluation of Locally Driven Innovations in Health Care Delivery

2015 – 2020

Project Overview

Objective

We examined 39 independent and diverse health care interventions funded under the second round of Health Care Innovation Awards (HCIA R2) by the Centers for Medicare & Medicaid Services (CMS) to identify locally driven service delivery models with evidence of improving care quality and reducing the need for costly health care services, the factors associated with lower health care service use and costs, and the strategies used to sustain the programs after the end of the awards.

Project Motivation

Under HCIA, the Center of Medicare and Medicaid Innovation (CMMI) made awards to test whether refining and broadening the innovative approaches that these providers were already using or had tested previously would yield improvements and efficiencies in delivering health care. 

Partners in Progress

  • RTI International
  • Mission Analytics Group
  • L&M Policy Research
  • Kennell and Associates.

Prepared For

U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation

The nearly 10-year HCIA initiative represented a new, bottom-up approach to testing innovative approaches to health care delivery. Building off the first round of awards in 2012, in which 107 organizations received over $826 million in funding, under HCIA R2 CMMI awarded nearly $322 million to 39 new organizations to implement innovative service delivery models and propose alternative payment systems to support them. 

The programs varied widely in the interventions provided, populations served, types of organizations involved, and number of beneficiaries enrolled. The diversity of the service delivery models provided a unique opportunity to test a wide range of locally driven innovations simultaneously, as well as determine whether any shared program or awardee characteristics were associated with a greater likelihood of reducing the need for costly health care services across a range of settings and populations. 

Mathematica and its partners conducted a comprehensive implementation and impact evaluation of the 38 awardees that remained in the program after the first year. We used a mixed-methods study design, tailored to the intervention features of each program, to assess whether the innovations reduced hospitalizations and emergency department (ED) visits, improved care quality, and lowered the total cost of care. We analyzed Medicare and Medicaid claims data; conducted surveys with program staff, physicians, and beneficiaries; conducted qualitative interviews with program administrators and frontline service providers; and analyzed program data collected for CMS.

Only four of the 19 programs for which we could produce valid impact estimates demonstrated statistically significant effects on hospital inpatient and ED service use and expenditures. When favorable results were achieved, they tended to be realized more through a reduction in emergency room visits than in hospitalizations and concentrated among higher-risk Medicare and Medicaid beneficiaries most likely to benefit from enhanced intervention services.

Service delivery models targeting patients with substantial nonmedical needs, using nonclinical staff, and focusing on individual patient care rather than transforming provider practice were more likely than programs without these features to reduce acute care and ED service use and lower medical spending. Health care interventions that included behavioral health, telehealth, and health information technology components were also more likely than programs without these components to reduce the need for costly health care services.

 
/-/media/internet/employee-photos/senior-staff_health-research/bgilman-10903.jpg

The HCIA initiative differed from most CMMI models because the awardees themselves developed the interventions. Given the range and innovative nature of the interventions that HCIA R2 tested, it is not surprising that many programs failed to achieve discernible impacts on health care costs, service use, and quality during the study period.

- Boyd Gilman, Senior Researcher

Related Staff

Boyd Gilman

Boyd Gilman

Principal Researcher

View Bio Page
Nancy McCall

Nancy McCall

Senior Fellow

View Bio Page
Stacy  Dale

Stacy Dale

Principal Researcher

View Bio Page
Danielle Whicher

Danielle Whicher

Researcher

View Bio Page
Laurie Felland

Laurie Felland

Principal Researcher

View Bio Page
John Schurrer

John Schurrer

Senior Researcher

View Bio Page