Projects
Evaluation of the Medicare Care Choices Model
2020–2023
Project Overview
Objective
To test whether eligible Medicare and dual-eligible beneficiaries would choose to receive supportive services if they could also still have Medicare pay for treating their terminal condition, and to determine the effect this might have on beneficiaries’ quality of care, satisfaction, and Medicare expenditures.
Project Motivation
Services available through the Medicare hospice benefit can greatly improve the quality of life for people with a terminal condition. Medicare beneficiaries have traditionally underused hospice services, however, in part because of a requirement that beneficiaries forgo payment for treatment of their terminal conditions to receive hospice services. Through the Medicare Care Choices Model, the Centers for Medicare & Medicaid Services Innovation Center is testing whether offering eligible beneficiaries the option to receive supportive services without forgoing payment for treating their terminal conditions would improve their quality of life and care, increase beneficiaries’ satisfaction, reduce Medicare expenditures, or lead to earlier election of the Medicare hospice benefit.
Prepared For
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation
Mathematica helps Medicare test whether offering eligible beneficiaries the option to receive supportive services at the end of life and continue to receive payment for other treatments improved the quality of care and reduced Medicare expenditures.
In 2016, the Centers for Medicare & Medicaid Services Innovation Center launched the Medicare Care Choices Model. The Innovation Center accepted 141 hospices in the model to offer services to Medicare fee-for-service beneficiaries at the end of life (that is, those expected to live less than six months) with a diagnosis of cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS. Eligible beneficiaries could receive supportive services without forgoing payment for treating their terminal conditions (which is required to enroll in the Medicare hospice benefit). Eligible beneficiaries were referred to participating hospices and could voluntarily enroll in the model. The model accepted enrollment from beneficiaries over a five-and-a-half-year period from January 1, 2016, to June 30, 2021. The model ended December 31, 2021.
Our mixed-methods evaluation broadly evaluates model implementation, estimates the model’s effects on quality of care and Medicare expenditures over the full model period, and synthesizes factors associated with successful model performance and outcomes.
Project Impact
Participant Experience & Evaluation Results
This video shares the perspectives of people who were involved in the Medicare Care Choices Model and highlights key findings from the evaluation. It conveys both the policy relevance of the model and the human importance of expanded options for end-of-life care.
Evidence & Insights From This Project
News
Expanded Access to End-of-Life Care Shows Promise for Improving Care Quality and Reducing Medicare Expenditures
An article from Health Affairs reports impacts from the evaluation of the Medicare Care Choices Model, which found improved end-of-life care, lowered Medicare expenditures, and increased hospice use.
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