Econometrica’s Evaluation of the Community-Based Care Transitions Program

CMS recently released an inaugural report titled, “Evaluation of the Community-based Care Transitions Program.” The report, authored by Econometrica, Inc., provides a summary of the progress and early results for the initial Community-Based Care Transitions Program (CCTP) sites that were awarded funding through 2012. Although CMS awarded CCTP agreements to 101 community-based organizations (CBOs) as of June 2013, Econometrica analyzed approximately 47 sites depending on data availability.

Background

CMS implemented the CCTP in April 2011 in accordance with section 3026(a) of the Patient Protection and Affordable Care Act (ACA) (P.L.111-148) to grant funding to hospitals and community-based entities that furnish high-value health care for sick and disabled Medicare beneficiaries who transition from inpatient hospitals to home or other care settings. The funding is awarded in five rounds. Care transition services are designed to improve quality of care, reduce readmissions to hospitals by high-risk beneficiaries, and achieve cost savings for the Medicare program. The CCTP is overseen by the CMS Innovation Center.

In August 2012, Econometrica contracted with CMS to design and conduct an evaluation of the CCTP to assess its impact on continuity of care and outcomes including readmissions, emergency department (ED) visits, observation stays, costs, patient experiences, and patient activation.

Report Structure

Econometrica’s evaluative research was based on site visits and interviews and focused on seven areas: (1) program implementation/operational issues; (2) beneficiary participation; (3) provider participation; (4) utilization and readmissions; (5) costs and/or savings; (6) quality monitoring and quality improvement; and (7) unintended consequences.

The report included “year one” data collection and sources; characteristics of CBOs, hospital partners, CCTP programs and markets and preliminary hypotheses; characteristics of CBOs, hospital partners, CCTP design, and market areas; program implementation; analyses of readmissions, ED visits, and observation services for year one data.

Site Characteristics

Among the many findings from the 47 sites, Econometrica discovered that in respect to design characteristics, 40 percent of the sites targeted the Medicare-aged-only population, and 40 percent targeted both aged and disabled beneficiaries. In 74 percent of sites, care transition workers were mostly trained in nursing and social work, while the other 26 percent of sites used community health workers and pharmacists or pharmacy techs in addition to nurses or social workers as coaches.

The Care Transitions Intervention (CTI) Model is the most frequently used by the sites, with 25 sites reporting using only CTI and 13 using CTI in combination with one or more other transition models. Nine sites did not use the CTI model at all.

Regarding CBOs, the average participating CBO was a Northeastern area agency on aging (AAA) or a combination of an AAA and an aging and disability resource center (ADRC), responsible for both program coordination and providing direct elder support services for the CCTP. The average CBO directly offered six or more types of elder services.

With respect to hospital partners, the analysis required that the partners were short-term general hospitals that provided acute-care services. As a result of this requirement, the typical hospital partner had fewer than 501 beds and above-national-average percentages of Medicare discharges.

Implementation Findings

Econometrica measured the time from which CMS granted the award to the sites and the sites’ actual CCTP implementation. Overall, 25 sites, or 53 percent, were able to implement the program and begin providing services within three months of receiving awards. Three of seven Round 1 sites, or 43 percent, were the most likely to meet individual monthly enrollment targets at least once by April 30, 2013; only 13 sites (28 percent) met individual monthly enrollment targets at least once by April 30, 2013.

Sites that achieved both early implementation and meeting monthly enrollment targets were considered the most successful of all the sites. Nine sites (19 percent) achieved success on both process performance measures; 20 sites (43 percent) achieved success on one measure; and 18 sites (38 percent) did not meet either goal.

Four of 48 CCTP sites had a significant reduction in readmission rates compared to the 2010 baseline rate. All four CBOs used the CTI model alone or in combination with elements of other models as well as social workers and nurses as coaches. These CBOs offered at least two elder services.