Evaluation of Programs of Coordinated Care and Disease Management (Coca)

This is a Congressionally mandated study. In the original study, 16 demonstration programs provided care coordination services to beneficiaries with chronic illness in Medicare's fee-for-service program. A five-year CMS-funded study tested whether the programs can improve patients' use of medical services, improve patients' outcomes and satisfaction with care, and reduce Medicare costs. The study also assessed physicians' satisfaction with the programs.

In 2008 Congress extended the project for two of the original programs--Mercy Medical Center - North Iowa and Health Quality Partners in Pennsylvania--and they will enroll Medicare beneficiaries and provide care coordination services into the spring of 2010.

Study Overview

• Status: Unknown
• Conditions: Coronary Artery Disease; Diabetes; Cancer; Chronic Obstructive Pulmonary Disease; Major Depression; Alzheimer's Disease; Congestive Heart Failure; Cerebrovascular Disease; Psychotic Disorder
• Intervention / Treatment: Behavioral: Care Coordination

Detailed Description

Mathematica Policy Research, Inc. (MPR) evaluated 16 independent demonstration sites that provide coordinated care interventions to Medicare beneficiaries with chronic illnesses. The rationale for the demonstration is the lack of coordination among the multiple providers typically serving Medicare beneficiaries with chronic illnesses, as well as the adverse consequences of the lack of coordination for the beneficiaries and for Medicare costs. The demonstration sites, selected in early 2001, offered programs designed to improve both the care that patients receive and patients' knowledge of, and adherence with, recommended self-care and behavior. The study estimated the effects of each site on patients' well-being and satisfaction, in addition to the site's effects on the use and cost of Medicare covered services. This analysis relied on a patient survey conducted 6 to 12 months after enrollment, and on Medicare claims data and any data available from the demonstration sites that could enhance the study. The study included two rounds of physician surveys. In each site, eligible applicants were randomly assigned to treatment and control groups. An extensive process analysis was conducted to describe the interventions in detail, with the key goal being an assessment of those factors that account for program success and failure. The study included case studies of each site, program profiles, interim site-specific memos, two interim summary reports, two reports to Congress (based on the interim summary reports), and a final summary report. This original study enrolled 18,277 beneficiaries.

In 2008 Congress extended the study for 2 of the sites, Mercy Medical Center - North Iowa and Health Quality Partners in Pennsylvania, and they will recruit beneficiaries and provide demonstration intervention services through the spring of 2010. Mathematica Policy Research will evaluate the results of this extended demonstration using Medicare claims data and qualitative site visits to the two programs.

• Study Type: Interventional
• Enrollment (Actual): 18277
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Phoenix, Arizona, United States, 85016
      • Hospice of the Valley MediCaring Project
  • District of Columbia
    • Washington, District of Columbia, United States, 20036
      • Georgetown University Medical Center-Mind My Heart Program
  • Florida
    • Sunrise, Florida, United States, 33323
      • Quality Oncology/Matria Healthcare
  • Illinois
    • Rosemont, Illinois, United States, 60018
      • CorSolutions/Matria Healthcare
    • Urbana, Illinois, United States, 61801
      • Carle Foundation and Hospital
  • Iowa
    • Mason City, Iowa, United States, 50401
      • Mercy Medical Center - North Iowa
  • Maine
    • Augusta, Maine, United States, 04330
      • Medical Care Development
  • Maryland
    • Baltimore, Maryland, United States, 21201
      • University of Maryland Medical Center
    • Catonsville, Maryland, United States, 21228
      • Charlestown/Erickson Retirement Communities
  • Missouri
    • St. Louis, Missouri, United States, 63110
      • Washington University-St.Louis School of Medicine/Barnes-Jewish Hospital
  • New Jersey
    • Eatontown, New Jersey, United States, 07724
      • QMed, Inc.
  • New Mexico
    • Albuquerque, New Mexico, United States, 87102
      • Lovelace Health Systems
  • New York
    • New York, New York, United States, 10025
      • Jewish Home Lifecare
  • South Dakota
    • Sioux Falls, South Dakota, United States, 57117
      • Avera McKennan Hospital and University Health Center
  • Virginia
    • Richmond, Virginia, United States, 23220
      • CenVaNet

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Meets clinical and prior health service use criteria of each of the 16 demonstration sites (vary across demonstration programs)
• Resides in catchment area of one of the programs
• Enrolled in Medicare fee-for-service program
• Coverage by both Medicare Parts A and B
• Medicare is primary payer

Exclusion Criteria:

• Does not meet any of the relevant program's exclusion criteria (vary across demonstration programs)
• Not enrolled in a Medicare Advantage plan (Medicare managed care program)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Care coordination, consisting variously (depending on the demonstration site)--nurse telephonic counseling, nurse in-person home visits, home telemonitoring equipment, and physician education and feedback.	Behavioral: Care Coordination; Depending on the demonstration site, may consist of nurse telephonic counseling and monitoring, nurse in-person or home visits, home telemonitoring equipment, patient educational materials, patient group educations classes, physician education and feedback.
No Intervention: Control; Usual care in Medicare fee-for-service from beneficiaries' physicians and other health care providers

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Medicare program expenditures	Eight years

Secondary Outcome Measures

Outcome Measure	Time Frame
Claims-based and patient-reported quality of care	Eight years

Collaborators and Investigators

• Sponsor: Mathematica Policy Research, Inc.
• Collaborators: Centers for Medicare and Medicaid Services
• Investigators: Study Director: Randall S. Brown, Ph.D., Mathematica Policy Research, Inc.; Study Director: Carol A. Magee, Ph.D., Centers for Medicare & Medicaid Services

Publications and helpful links

General Publications

• Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009 Feb 11;301(6):603-18. doi: 10.1001/jama.2009.126.

Helpful Links

• The Evaluation of the Medicare Coordinated Care Demonstration: Findings for the First Two Years

Study record dates

Study Major Dates

• Study Start: September 1, 2000
• Primary Completion (Actual): August 1, 2015
• Study Completion (Anticipated): December 1, 2016

Study Registration Dates

• First Submitted: February 15, 2008
• First Submitted That Met QC Criteria: February 28, 2008
• First Posted (Estimate): February 29, 2008

Study Record Updates

• Last Update Posted (Estimate): October 1, 2015
• Last Update Submitted That Met QC Criteria: September 29, 2015
• Last Verified: September 1, 2015

More Information

Terms related to this study

• Keywords: Elderly; Disease management; Medicare; Care coordination; Fee-for-service; Random assignment
• Additional Relevant MeSH Terms: Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Respiratory Tract Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Lung Diseases; Neurocognitive Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Neurodegenerative Diseases; Coronary Disease; Dementia; Tauopathies; Heart Failure; Coronary Artery Disease; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Psychotic Disorders; Mental Disorders; Alzheimer Disease; Cerebrovascular Disorders
• Other Study ID Numbers: MPR 8756; CMS 500-95-0047(09