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.

Read more about the Medicare Care Choices Model.

Related Staff

Keith Kranker

Keith Kranker

Principal Researcher

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Boyd Gilman

Boyd Gilman

Principal Researcher

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Arnold Chen

Arnold Chen

Senior Researcher

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Sandi Nelson

Sandi Nelson

Principal Data Analytics

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Matthew Niedzwiecki

Matthew Niedzwiecki

Researcher

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R. Vincent Pohl

R. Vincent Pohl

Senior Researcher

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Patricia Rowan

Patricia Rowan

Senior Researcher

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Danielle Whicher

Danielle Whicher

Researcher

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Jonathan Gellar

Jonathan Gellar

Senior Statistician

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