Case Studies

From multi-year task orders with a team of subcontractors to smaller-scale individual research efforts, L&M has led dozens of research projects from government agencies, as well as private clients.

External Quality Review Organization

District of Columbia (under subcontract to Delmarva Foundation), February 2007 through January 2011

Objective:

Assist the District of Columbia’s Department of Health Care Finance (DHCF) in evaluating the quality of care provided to Medicaid recipients enrolled in a managed care organization (MCO) by serving (with Delmarva Foundation) as the External Quality Review Organization (EQRO).

Challenges:

Because of the number of standards and the short timeframe for conducting the compliance reviews, the project required a thorough understanding of health care regulations, as well as an efficient, organized, and detail-oriented approach that helped the MCOs prepare the required information for the on-site reviews.

Approach:

Prior to the 2010 review, the team assisted with the development of comprehensive guidance for the MCOs, detailing the specific items required to document compliance with Medicaid regulations and DHCF contract standards, in addition to outlining the objectives, timelines, and process for the annual review.

The team completed desk and on-site reviews with each MCO operating a Medicaid plan in the District of Columbia, assessing the plans’ compliance with a set of performance standards based on the Centers for Medicare & Medicaid Services (CMS) document, “A Health Care Quality Improvement System (HCQIS) for Medicaid Managed Care,” the Code of Federal Regulations, and DHCF requirements. In its review findings, the team documented the level of compliance for each element and component and provided detailed recommendations to assist DHCF and MCOs in addressing any compliance issues.


Results

Our Team
  • Improved the transparency of the review process by working with DHCF to identify key objectives for the 2010 review and assisting with the development of written guidance to communicate these objectives to the MCOs.
  • Optimized review efficiency by developing and implementing a pre-site visit survey, standardizing the process for collecting and cataloging plan documentation, and drafting and employing detailed checklists to ensure thorough, consistent, and fair reviews.
  • Provided actionable recommendations to assist DHCF and Medicaid MCOs in improving the quality of care for more than 100,000 Medicaid managed care enrollees in the District of Columbia.

Medicare Advantage Plan and Benefit Trends and MA-FFS Cohort Analyses

Centers for Medicare & Medicaid Services (CMS), September 2008 through September 2009 (Base Year)

Objective:

Assist CMS in understanding trends in benefits and cost-sharing arrangements in Medicare Advantage (MA) plans and how these impact beneficiaries, particularly those with chronic conditions.

Challenges:

The team was tasked with analyzing and then summarizing hundreds of dimensions of MA plans in a meaningful way. This required both the technical expertise to build and work with a data set incorporating several years of data and multiple data sources, as well as the ability to highlight the most important findings and translate complex statistical analyses for a policy-making audience. Another challenge involved pricing out-of-pocket costs for individuals with chronic conditions when no claims data for these individuals were available, requiring a sophisticated matching analysis, as well as a side analysis to test the validity of the approach.

Approach:

L&M analyzed Health Plan Management System (HPMS) data for each MA plan to understand how premiums, cost sharing, and supplementary benefits had been changing over the period 2006 to 2010; how these changes impacted the average consumer; and how the impacts varied by geographic location and plan type. For the impact analysis, the team focused on variations in out-of-pocket costs for Medicare beneficiaries with chronic conditions under fee-for-service (FFS) compared to those enrolled in MA plans. The team created a matched sample of FFS and MA-enrolled beneficiaries and developed a complex algorithm using Medicare claims data to assess utilization patterns across FFS chronic condition cohorts. These utilization patterns were then mapped to the MA plan benefits structures to calculate out-of-pocket costs for MA-enrolled beneficiaries with different chronic conditions at different severity levels and identify drivers of higher out-of-pocket costs. A side analysis using Medicare Expenditure Panel Survey data, which includes utilization for individuals in FFS and MA, was conducted to validate the appropriateness of applying FFS utilization patterns to an MA population.


Results

Our Team
  • Organized, analyzed, and deciphered a vast amount of data to provide a snapshot of changes in MA plans and how these changes impacted beneficiaries
  • Helped CMS better understand the out-of-pocket costs of beneficiaries with chronic conditions, elucidating the plan features that most impacted these costs for different conditions
  • dentified areas of focus to improve monitoring and oversight of MA plans

CMS has exercised the first three option years under this task order contract; the team is continuing longitudinal analyses of plan and benefit trends and MA-FFS cohort analyses through the 2013 contract year.

Adding Hospital Readmission Data to the Hospital Compare Web Tool

Centers for Medicare & Medicaid Services (CMS), September 2008 – February 2009

Objective:

Assist CMS in integrating quality information related to hospital readmission rates into the Hospital Compare Web tool.

Challenges:

The team was tasked with developing concise, consumer-friendly explanations and displays of highly technical information. Health care quality measures are often difficult for consumers to understand and use, but the complexity of the readmission measures, which rely on a complicated risk adjustment methodology, heightened the challenge.

Approach:

With input from CMS and a panel of experts, L&M drew on its technical expertise in health care quality and plain language communications to develop language and paper-based mockups of hospital readmission information. The mockups were consumer tested using one-on-one cognitive interviews to assess participants’ comprehension of and reaction to the information. During the second phase, L&M oversaw the development of a Web-based prototype incorporating revised language and displays, which was tested with both consumers and clinicians.

Based on the research, L&M developed screen-by-screen recommendations for integrating the readmission information into the Web tool. The team then hosted a call with CMS staff and contractors to discuss how to fine-tune the recommendations to balance CMS’s policy, communications, and technology needs for the integration.


Results

Our Team
  • Optimized consumer understanding of the readmissions measures while ensuring the technical accuracy of the information throughout the textual descriptions and graphical displays
  • Enhanced consumer interpretation by developing measure descriptions and supporting information based on participant reactions to the information
  • Assisted CMS in appropriately layering the information on the site so that users are introduced to increasingly detailed explanations of the measures as they seek additional information within the Web tool