Online Program

Using orthogonal designs to study care coordination delivery to individuals with severe and persistent mental illness

Randy Brown, Mathematica Policy Research 
*Jelena Zurovac, Mathematica Policy Research 

Keywords: experimental design, orthogonal design, care coordination, individuals with special needs, mental health,

This presentation will illustrate new applications of orthogonal designs to evaluate components of care coordination models, specifically to identify which components influence patient outcomes. Special Needs Plans (SNPs) were established in 2003 as part of the Medicare Prescription Drug, Improvement, and Modernization Act, with the goal of improving care for three high-risk populations of Medicare beneficiaries: (1) dual eligibles (those enrolled in both Medicare and Medicaid), (2) beneficiaries with chronic conditions, and (3) beneficiaries residing in nursing homes. SNPs contract with CMS to provide all covered Medicare services in return for a monthly risk-adjusted capitation payment. Thus, SNPs have the incentive—and the requirement, under their contract with CMS—to engage in care management to help patients reduce their need for expensive services, especially hospitalizations and emergency room visits. Although many protocols, interventions, and screening tools exist, SNPs still have many questions about the most efficacious and cost-effective ways to design and implement interventions to address the unique and varied needs of the high-risk populations they serve. In collaboration with three SNPs serving dual eligibles, we designed and are conducting a randomized, orthogonal design study to help SNPs identify care coordination strategies that work best for their members. The main outcomes of interest are hospital admissions, readmissions, and emergency room visits. This application of orthogonal design will focus on our findings for a SNP that serves dual eligibles with severe and persistent mental illness. At this SNP, 25 care coordinators are implementing either current practice or an enhanced practice for each of 11 interventions over a 12-month period. The studied intervention variants address how often an intervention is provided, or which procedures or protocols are used in: conducting routine contacts with patients, medication management, depression screening, patient education and coaching, integration of mental health and medical care, and management of care transitions