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Evaluation of Programs of Coordinated Care and Disease Management

Open (Enrolling)
Congestive Heart Failure, Diabetes, Coronary Artery Disease, Chronic Obstructive Pulmonary Disease, Cancer, Cerebrovascular Disease, Alzheimer's Disease, Psychotic Disorder, Major Depression

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Trial Information

Evaluation of Programs of Coordinated Care and Disease Management

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.

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)

Type of Study:


Study Design:

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Outcome Measure:

Medicare program expenditures

Outcome Time Frame:

Eight years

Safety Issue:


Principal Investigator

Randall S. Brown, Ph.D.

Investigator Role:

Study Director

Investigator Affiliation:

Mathematica Policy Research, Inc.


United States: Institutional Review Board

Study ID:

MPR 8756



Start Date:

September 2000

Completion Date:

December 2010

Related Keywords:

  • Congestive Heart Failure
  • Diabetes
  • Coronary Artery Disease
  • Chronic Obstructive Pulmonary Disease
  • Cancer
  • Cerebrovascular Disease
  • Alzheimer's Disease
  • Psychotic Disorder
  • Major Depression
  • Care coordination
  • Disease management
  • Medicare
  • Fee-for-service
  • Random assignment
  • Elderly
  • Alzheimer Disease
  • Cerebrovascular Disorders
  • Coronary Artery Disease
  • Myocardial Ischemia
  • Coronary Disease
  • Depression
  • Depressive Disorder
  • Heart Failure
  • Lung Diseases
  • Respiration Disorders
  • Pulmonary Disease, Chronic Obstructive
  • Psychotic Disorders
  • Mental Disorders
  • Depressive Disorder, Major
  • Lung Diseases, Obstructive



Avera McKennan Hospital and University Health Center Sioux Falls, South Dakota  57105
Lovelace Health Systems Albuquerque, New Mexico  87108
University of Maryland Medical Center Baltimore, Maryland  21201-1595
Mercy Medical Center - North Iowa Mason City, Iowa  50401
Hospice of the Valley MediCaring Project Phoenix, Arizona  85016
Georgetown University Medical Center-Mind My Heart Program Washington, District of Columbia  20036
Quality Oncology/Matria Healthcare Sunrise, Florida  33323
CorSolutions/Matria Healthcare Rosemont, Illinois  60018
Carle Foundation and Hospital Urbana, Illinois  61801
Medical Care Development Augusta, Maine  04330
Charlestown/Erickson Retirement Communities Catonsville, Maryland  21228
Washington University-St.Louis School of Medicine/Barnes-Jewish Hospital St. Louis, Missouri  63110
QMed, Inc. Eatontown, New Jersey  07724
Jewish Home Lifecare New York, New York  10025
CenVaNet Richmond, Virginia  23220