MDRC is currently conducting evaluation of coordinated care programs in Colorado and New York.
Colorado. The evaluation in Colorado is currently taking place in six counties: Adams, Arapahoe, Boulder, Weld, Denver, and Jefferson. In these counties, two versions of coordinated care are being tested, with services provided by Colorado Access or Kaiser Permanente.
Both organizations have developed coordinated care programs that are similar to ones they have used with high-needs Medicare patients. Each program has several goals. One is to reduce the use of Emergency Departments for routine care by establishing a primary care provider for each patient and helping the patient make and keep appointments. A second is to help patients comply with treatment recommendations — such as taking medications, making follow-up appointments, and eating well — to keep chronic conditions from worsening to the point where hospitalizations are needed. Care managers will begin by assessing each individual’s health care and social service needs in order to develop individualized care plans. A patient whose care needs seem to be well managed will receive limited care management, while one who is struggling with multiple chronic conditions will receive more intensive care management. For example, a diabetic patient with pulmonary disease and a substance abuse problem might be contacted by a care manager several times a week to assess the person’s medical needs, help them make appointments to see appropriate health care providers, and monitor their compliance with recommended actions, such as taking medications, following an appropriate diet, and checking blood sugar levels. The care manager would also try to work with the patient’s primary care physician to make sure someone is coordinating care across the variety of specialists that the patient is likely to see. Although protocols would provide care managers with suggestions for what is appropriate care, the care managers will have substantial discretion to do what is necessary to help patients receive high-quality, appropriate care.
The evaluation of this program is building off of a state plan to phase in coordinated care. In 2008, a randomly chosen portion of eligible Medicaid patients in Adams, Arapahoe, Boulder, and Weld counties who are currently in the fee-for-service system were sent a letter saying they had been enrolled in the Colorado Access managed care program and telling them how they could opt out of the program. The remainder will remain in fee-for-service care for at least two years from the date of random assignment. Because the group that was passively enrolled in the Colorado Access program was chosen at random, any differences that emerge in health care and health outcomes between the two groups over the following two years can be reliably attributed to the Colorado Access program. In 2009, a similar process began for the Kaiser Permanente pilot. Random assignment has now ended for both pilots, and services for the Colorado Access pilot have now ended.
New York. In New York, the state legislature approved funding for the Chronic Illness Demonstration Project (CIDP), which will provide coordinated care for high-needs Medicaid beneficiaries with multiple chronic conditions in New York’s fee-for-service Medicaid system. In January 2009, the state announced that six programs had been funded, three in New York City, and one each in Nassau, Westchester, and Erie (Buffalo) Counties. Programs began operations in summer 2009.
Individuals are eligible for CIDP services if they are currently receiving fee-for-service Medicaid and are likely to be hospitalized in the coming year according to a predictive model developed by John Billings at New York University. This is a high-needs group. On average, they are hospitalized about three times a year and use nearly $60,000 per year in Medicaid benefits. About three-quarters have been diagnosed with a mental illness and four-fifths have been diagnosed with a substance abuse problem. They also suffer from a range of other chronic conditions. Increasing primary care and reducing emergency department and hospital use for this group may result in substantial savings to the health care system.