Performance Improvement 2005. Multi-state Evaluation of Dual Eligibles Demonstration Final Report


This report evaluated several state demonstration programs designed to create alternative delivery services for the dually eligible - people who are eligible for both Medicare and Medicaid. This report analyzed the utilization of services, costs, and quality for one of the demonstration projects, Minnesota Senior Health Options (MSHO). The design included a survey of enrollees and two matched control groups: One selected from the same geographic areas where the plans operate (i.e., composed of persons who were eligible but declined to participate), and a second from comparable locations in the state where the plan is not offered. Encounter and fee-for-service claims data for both the MSHO enrollees and control groups were analyzed to determine if the outcomes of care, including inpatient hospitalization, emergency room visits, and preventable hospitalizations, were different for MSHO compared to control groups. In general, the results of this evaluation were mixed. Major findings included: (1) MSHO had some impact on the process of care, providing more of some types of preventive and community care services for community residents, although the number of face-to-face provider visits was significantly less than either control group and there was no consistent measurable effect on the various outcomes or indicators of quality care measured in this study for community residents. (2) MSHO nursing home enrollees had significantly fewer hospitalizations, emergency room services and preventable emergency services than either control group. (3) There was a greater effect on preventable emergency room visits and preventable hospitalizations with increased exposure to MSHO for community residents. (4) The cost to the government, both state and federal, was higher under MSHO compared to fee-for-service Medicare and a combination of capitated Medicaid and fee-for-service Medicaid payments.

PIC ID: 7186; Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information; Federal Contact: Rudolph, Noemi, 410-786-6662; Performer: University of Minnesota, Minneapolis, MN

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