Financial Alignment Demonstrations for Dual Eligible Beneficiaries: A Look at CMS’s Evaluation Plan
- The evaluation will include both qualitative and quantitative methods. Qualitative information will be based on site visits, including interviews with state staff; beneficiary focus groups; and stakeholder interviews. Quantitative information will be based on implementation tracking data reported by states and analysis of claims, encounter, quality, utilization, and cost data. Each state’s demonstration will have a comparison group of similar beneficiaries unaffected by the demonstration. The evaluation will not include a beneficiary survey.
- The evaluation will profile each state’s care delivery system prior to the demonstration, identify key elements that the state’s demonstration intends to change, and measure the effects of any changes. It will describe major demonstration design features in each state and compare those features across demonstration states. Other areas of focus in the evaluation include beneficiary experience, utilization and access to care, quality of care, costs, subpopulations and health disparities.
- The evaluation results will be reported at regular intervals. The evaluation plan calls for state-specific initial (based on the first six months of implementation), quarterly, annual, and final reports, as well as an aggregate final evaluation report. While the law requires the evaluation results to be publicly available, the evaluation plan does not specify which of these reports will be released publicly or when.
The evaluation plan acknowledges that the analysis may be limited by the quality and availability of claims and encounter data. As the evaluation progresses, it will be important for timely results and reports to be publicly available to promote broad discussion of the demonstrations’ successes and challenges.
also of interest
- Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS
- Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries
- Medicaid's Role for Dual-Eligible Beneficiaries