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.
Centers for Medicare & Medicaid Services (CMS), July 2012 through December 2016
Evaluate the extent to which the Center for Medicare & Medicaid Innovation’s (CMMI’s) Pioneer and Advance Payment Medicare Shared Savings Program (AP MSSP) ACOs improved population health, improved the quality of care, and controlled the cost of care and determined which organizational characteristics, strategic decisions, and operational practices contributed to achieving program goals.
The L&M team and our partner organizations were tasked with determining the effect that CMMI-supported ACOs had on population health, cost and quality. Given that participation in the program was voluntary and non-random, the team was challenged to devise comparison groups to determine the effect of the ACO initiative. This required building and working with a multi-year data set from numerous sources to create comparison groups that shared key attributes with each of the ACO (intervention) market. In addition, another challenge this analysis presented was the intervention was not specified; meaning organizations could design their own approach to meeting the three goals of the program (improve population health, quality of care and control cost of care). In order to understand the many approaches to responding to the intervention, the team collected and synthesized information about these complex organizations across a wide range of topics, e.g., leadership and governance, provider network development and engagement, marketplace/environment, organizational performance evaluation, financial planning and management, care management, information management/ health information technology (HIT) physician engagement / performance evaluation and access to care.
The L&M team employed a mixed methods approach that included collecting and analyzing primary data collection, as well as secondary data analyses. In the final analysis, these activities were complementary. The team collected primary data through quarterly telephone assessments and site visits with a cohort of 80 Medicare ACOs comprising both intervention and comparison ACOs. These data were recorded in Dedoose (a qualitative analysis software) and coded to facilitate analyses of the interviews. Secondary data were drawn from the CMS Chronic Condition Warehouse (CCW), which includes administrative data, such as the Master Beneficiary Summary Files (MBSF) as well as claims data. The team prepared a master analytic file that linked MBSF, Hierarchical Condition Categories (HCC), and claims files. Using this file, the team identified a baseline and performance year treatment group of beneficiaries assigned/aligned to the CMMI ACOs as well as baseline and performance year comparison groups of Medicare beneficiaries.